Sometimes, surgery is used to relieve symptoms, such as a blocked bowel caused by the recurrence. In select patients, surgery for debulking of cancer is also an option. It is important to stress again that you, in consultation with your doctor, should set realistic goals for what to expect from treatment.
This may mean weighing the possible positive outcomes of a new treatment against the possible negative ones. At some point, a woman may decide that continuing treatment is unlikely to improve her health or survival. A woman must be certain that she is comfortable with her decision whatever it is. Additional debulking surgery to remove as much persistent cancer as possible should be considered before resuming additional systemic treatment.
Even with additional surgery additional systemic treatment is still necessary since undetectable microscopic deposits of cancer still exist and cause recurrences even after successful debulking surgery. Patients should consider participation in a clinical trial evaluating new systemic treatment approaches.
Both the effectiveness and type of available therapy depends on the first-line systemic therapy received, the length of time since finishing treatment and the extent of recurrent cancer. The length of time between the completion of first-line chemotherapy and the development of recurrent cancer affects treatment options. Patients who develop recurrent cancer more than 6 months after first-line chemotherapy can experience another remission following treatment with the identical first-line chemotherapy that was previously used.
Patients who develop recurrent cancer within 6 months from first-line chemotherapy are less likely to improve with the same anti-cancer drugs and should consider treatment with a different chemotherapy regimen.
All patients with recurrent cancer should also consider participating in clinical trials. Debulking surgery to remove as much cancer as possible may be considered before resuming treatment. Over half of patients who develop a recurrence longer than 12 months from initial treatment are likely to improve with further systemic treatment, compared with less than half of patients who develop a recurrence between 6 and 12 months from initial treatment. PARP inhibitors are a new class of precision cancer medicines that contribute to cancer cell death and increased sensitivity to chemotherapy.
By blocking the PARP enzyme, DNA inside the cancerous cells is less likely to be repaired, leading to cell death and possibly a slow-down or stoppage of tumor growth. Postoperative image in June a. MRI showed no obvious local lesion. CT showed tumor disappeared, with only radioactive seeds remaining. Epithelial ovarian cancer EOC always remains the most lethal gynecologic malignancy, guideline-recommended treatments for advanced ovarian cancer is primary debulking surgery followed by platinum-based chemotherapy.
However, relapse would almost unavoidable. Other researches in ovarian cancer in progress include multiline or dose-dense chemotherapy and targeted agents such as PARP inhibitors, Anti-angiogenic agents, immunotherapies. Dose-dense weekly paclitaxel scheme in epithelial ovarian cancer has obtained remarkable attention in the past decade.
However, the efficacy of chemotherapy alone is limited. Chen, Wei-Chun et al. The median disease-free survival DFS was 5. Target therapy mainly including PARP inhibitors and anti-angiogenic agents which demonstrating efficacy with improved PFS and OS are mainly used as maintenance therapy for patients with recurrent ovarian cancer [ 3 , 4 , 5 , 6 ].
In recent years, these inhibitors are being investigated in clinical trials. Inconsistent results have been obtained between studies. Some reports demonstrate a survival benefit with increased PD-L1 tumor expression, while others have shown a negative result [ 8 , 9 ].
For EOC, radiotherapy is not a routinely therapy. In recent years, studies have reported some favorable outcomes in patients with recurrent epithelial ovarian cancer treated with radiotherapy. Chang, JS et al.
The overall and complete response rates were The 2-year PFS rate was The role of secondary cytoreductive surgery SCS in recurrent epithelial ovarian cancer is yet controversial.
For platinum-sensitive recurrent ovarian cancer, SCS increases survival rate. In a case-control study, Marchetti, C et al. Twenty-three women undergone SCS and followed by platinum-based chemotherapy and olaparib maintenance. The other 23 women only received medical treatment.
However, Coleman RL et al. The median OS was They concluded that secondary cytoreductive surgery followed by chemotherapy did not result in longer overall survival than chemotherapy alone. The postoperative residual tumor mass is the most important prognostic factor. Indication to Secondary cytoreductive surgery should be individualized. Early diagnosis of recurrence is the key of the possibility of surgery and complete cytoreduction would improve the prognosis.
One advantage of our case is early diagnosis of recurrence. Regular follow-up and early diagnosis of recurrence is of great importance for EOC after primary therapy. If the recurrence is isolated, there maybe the chance of secondary cytoreductive surgery and relatively good prognosis.
Unfortunately, cases with isolated recurrences are not common. Many cases have disseminated lesions at the time of diagnosis.
The rigorous surveillance of patients after primary treatment is a challeng in clinical practice. In this case report, PET-CT discovered metastatic foci in early-stage even if the serum tumor marker remains in normal range.
Highly alertness of recurrence in the follow-up of EOC patients is important. With the help of high-quality image, clinicians could correctly monitor patients, distinguish relapse patterns and preform correct management management [ 14 ]. Most of the recurrent lesions were near or adhered by even infiltrated surrounded important organs such as ureter, vagina, cyst, intestine or rectum.
Sometimes tumors could not be removed because their removal would cause severe functional disability or life-threatening bleeding. Since reported by Brunschwig [ 15 ] in , the pelvic exenteration PE has become an important method to treat pelvic malignancies.
However, such management has remained controversial because of its severe functional disability or heavy hemorrhage especially when the tumor fixed to the pelvic sidewall. New treatment strategies for unremovable lesion in secondary cytoreductive surgery for recurrent ovarian cancer are needed.
Ovarian cancer often is at an advanced stage by the time it is diagnosed. Most women newly diagnosed with ovarian cancer have initial surgery first to remove as much of the tumor as possible, usually followed by chemotherapy. Data from and since the s consistently suggested that the less cancer that remains after surgery, the better patients do, Dr. Kohn said. Casablanca said. In addition, she continued, it was thought that surgery might be able to remove some tumor tissue that is resistant to chemotherapy.
However, Dr. The trial enrolled women with recurrent ovarian cancer that had responded to at least three cycles of platinum-based chemotherapy and who had gone 6 months or longer since last receiving platinum-based chemotherapy.
Participants also had to have disease that the study investigators believed could be completely removed surgically. Patients with these characteristics were thought to be the most likely to benefit from a second surgery, Dr. Coleman said. Of the patients, were randomly assigned to secondary surgery followed by standard chemotherapy, and were assigned to receive chemotherapy alone. Median overall survival was Although trial participants who underwent secondary surgery reported that their quality of life decreased immediately after surgery, quality of life in the surgery and no-surgery groups was similar after recovery from surgery.
Another component of the GOG trial tested the effectiveness of adding bevacizumab to standard chemotherapy in patients who were not considered good candidates for surgery. Results of that part of the trial, which showed that bevacizumab modestly improved overall and progression-free survival , were published in Genentech, which manufactures bevacizumab, also provided support for the trial under a Cooperative Research and Development Agreement with NCI.
When researchers designed the trial, more than 10 years ago, they expected to see a survival benefit from surgery, Dr. To investigate this possibility, the team compared only those patients for whom surgery removed all visible tumor, as reported by the surgeon, with the no-surgery group.
But, Dr. Another surprise was that participants in the trial lived nearly three times longer than had been expected when the trial was designed. The results of the trial demonstrate that progression-free survival may be prolonged for a few months by surgery, Dr. All in all, Dr. Casablanca echoed. A few other ongoing phase 3 trials are comparing surgery and chemotherapy with surgery alone for recurrent ovarian cancer.
For that reason, she said, she believes the results of the GOG trial should lead to an immediate change in practice. September 30, , by NCI Staff. September 28, , by NCI Staff. September 9, , by NCI Staff. Menu Contact Dictionary Search. Understanding Cancer.
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