abstract:
What Characterizes Long-term Survivors of Recurrent Ovarian Cancer? Case Report and Review of the Literature
Background: Women with recurrent ovarian cancer have a poor prognosis
and short survival. However, some women are long-term
survivors and it is unclear whether they share
specific common characteristics.
Case Report: We present the case of a
63-year-old
woman with histologically-proven recurrent ovarian
cancer and a survival time of
16 years after the diagnosis of
recurrence.
She underwent initial debulking surgery in 1994,
followed by 6 cycles of adjuvant chemotherapy with cisplatin and
paclitaxel.
After recurrent disease was diagnosed by
re-laparotomy in 2000, she underwent four lines of systemic chemotherapy
from 2000
to 2009 (carboplatin/paclitaxel, topotecan,
etoposide/treosulfan and liposomal doxorubicin) and four lines of
endocrine therapy
between 2002 and 2014 (tamoxifen, goserelin,
tamoxifen and exemestane). In 2014, she underwent secondary debulking
surgery
and was tumor-free until 2015. Upon progression,
she was then started on the fifth-line of endocrine therapy,
fulvestrant,
which was changed to the mTOR inhibitor everolimus
in June 2016.
In a PUBMED literature search, 360 cases of long-term
survivors
of recurrent ovarian cancer (LTSROC), defined as
women with survival >5 years after the diagnosis of recurrence, were
identified
with a mean post-recurrence survival time of 7.5
years. Comparing the patient and therapy details of these women, we
identified
common characteristics of LTSROC, i.e. young age
and optimal debulking at initial surgery, a long time span between
first-line
therapy and first recurrence and the combined use
of optimal cytoreductive surgery and systemic chemotherapy.
Conclusion:
LTSROC are rare, with 360 cases described in the
literature. LTSROC are characterized by young age, low tumor stage, long
recurrence-free interval and combined modality
treatment with optimal cytoreductive surgery and systemic chemotherapy.