• Predictive factors of cytoreduction: laparoscopy diagnostic as treatment of choice in patients with advanced forms of serous ovarian cancer
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Predictive factors of cytoreduction: laparoscopy diagnostic as treatment of choice in patients with advanced forms of serous ovarian cancer

HEALTH OF WOMAN. 2019.9(145): 72–75; doi 10.15574/HW.2019.145.72
V. Svintsitskiy, A. Rekuta
National Cancer Institute, Kiev

Ovarian cancer (OC) holds the first place in a structure of mortality among oncogynecology diseases all over the world. Complex approach in treatment of advanced forms of serous ovarian cancer (SOC) (stages III-IV by FIGO) – suggests a combination of surgery and chemotherapy methods – as the world standard. Nowadays, use of operative intervention at the preliminary stage of treatment (primary cytoreduction) is regarded as preferred and contributes to remote therapy results in women, if compared to those patients whose treatment started with the courses of neoajuvant chemotherapy. Nevertheless, just volume of residual tumor belongs to the most important predictive factors in patients with SOC, therefore, depth of cytoreductive surgery completion is considered to be a mainstay in treatment of such women.

Macroscopic absence of residual tumor – its full cytoreduction is referred to as the «gold standard» in surgery treatment of OC. At present, there are no efficient methods which would allow to predict a full extent of cytoreduction and, as a result, to identify the group of patients with justified neoajuvant chemotherapy and the next cytoreduction in intervals, as well as women who will benefit from performing primary cytoreduction.

Diagnostic laparoscopy for assessment of tumor process spreading and predicting the volume of cytoreduction was first time conducted in 1998. Until presently, only 1 randomized study (the Netherlands, 2016) had been carried out with participation of 201 women to evaluate effectiveness of diagnostic laparoscopy as a predictive factor of cytoreduction. The other studies were conducted as non-randomized pro– and retrospective. Review of literature proposed in the article allows introducing the data and all results of such studies. Use of laparoscopy as the predictor of cytoreduction in combination with radiology diagnostic methods allows making much personalized approaches in therapy of women with advanced forms of SOC and therefore, will contribute to better remote results of treatment.

Key words: serous ovarian cancer, diagnostic laparoscopy, cytoreductive surgery.

REFERENCES

1. Siegel RL, Miller KD, Jemal A. 2018. Cancer statistics, CA Cancer J. Clin. 68 (1):7–30. https://doi.org/10.3322/caac.21442; PMid:29313949

2. Fedorenko ZP, Hulak LO, Mykhailovych YuI. 2019. Biuleten Natsionalnoho kantser-reiestru № 20 – «Rak v Ukraïni, 2017-2018»: 101-9.

3. DiSilvestro PA. 2019. Shaping the standard of care in ovarian cancer management: A review of Gynecologic Oncology Group. Gynecol. Oncol. 1-145.

4. Kehoe S, Hook J, Nankivell M et al. 2015. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): An open-label, randomised, controlled, non-inferiority trial. Lancet 386:249-257. https://doi.org/10.1016/S0140-6736(14)62223-6

5. Vergote I, Trope CG, Amant F et al. 2010. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943-953. https://doi.org/10.1056/NEJMoa0908806; PMid:20818904

6. Chang SJ, Bristow RE. 2012. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: Redefining ‘optimal’ residual disease. Gynecol Oncol 125(2):483-92. https://doi.org/10.1016/j.ygyno.2012.02.024; PMid:22366151

7. Du Bois A, Reuss A, Pujade-Lauraine E, Harter P, RayCoquard I, Pfisterer J. 2009. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 115(6): 1234–44. MEDLINE: 19189349. https://doi.org/10.1002/cncr.24149; PMid:19189349

8. Vernooij F, Heintz P, Witteveen E, van der Graaf Y. 2007. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol. 105(3): 801-8. https://doi.org/10.1016/j.ygyno.2007.02.030; PMid:17433422

9. Chi DS, Zivanovic O, Palayekar MJ, Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Leitao MM, Brown CL, Barakat RR. 2009. A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma. Gynecol Oncol. Jan. 112(1):6-10. https://doi.org/10.1016/j.ygyno.2008.10.010; PMid:19100916

10. Muallem M.Z., Parashkevova A, Almuheimid J, Richter R, Diab Y, Braicu EI, Sehouli J. 2017. Preoperative CA-125 Values as a Predictive Factor for the Postoperative Outcome in Primary Serous Ovarian Cancer Anticancer Res. Jun 37(6):3157-3161. https://doi.org/10.21873/anticanres.11674

11. Bristow RE, Duska LR, Lambrou NC, Fishman EK, O’neill MJ, Trimble EL et al. 2000. A model for predicting surgical outcome in patient with advanced ovarian carcinoma using computed tomography. Cancer 89:1532–40. https://doi.org/10.1002/1097-0142(20001001)89:7<1532::AID-CNCR17>3.0.CO;2-A

12. Vergote IB, De Wever I, Decloedt J, Tjalma W, Van Gramberen M et al. 2000. Neoadjuvant chemotherapy versus primary debulking surgery in advanced ovarian cancer. SeminOnco. 127: 31-36.

13. Angioli R, Palaia I, Zullo MA, Muzii L, Manci N. 2006. Diagnostic open laparoscopy in the management of advanced ovarian cancer. Gynecol Oncol. 100: 455-461. https://doi.org/10.1016/j.ygyno.2005.09.060; PMid:16325244

14. Fagotti A, Fanfani F, Ludovisi M, Lo Voi R, Bifulco G et al. 2005. Role of laparoscopy to assess the chance of optimal cytoreductive surgery in advanced ovarian cancer: a pilot study. Gynecologic Oncology 96: 729-735. https://doi.org/10.1016/j.ygyno.2004.11.031; PMid:15721418

15. Fagotti A, Ferrandina G, Fanfani F, Ercoli A, Lorusso D et al. 2006. A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study Ann Surg Oncol. 13: 1156-1161. https://doi.org/10.1245/ASO.2006.08.021; PMid:16791447

16. Fagotti A, Ferrandina G, Fanfani F, Garganese G, Vizzielli G. 2008. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. Am J Obstet Gynecol. 199: 642. https://doi.org/10.1016/j.ajog.2008.06.052; PMid:18801470

17. Brun JL, Rouzier R, Selle F, Houry S, Uzan S. 2009. Neoadjuvant chemotherapy or primary surgery for stage III/IV ovarian cancer: contribution of diagnostic laparoscopy. BMC Cancer. 9: 171. https://doi.org/10.1186/1471-2407-9-171; PMid:19500391 PMCid:PMC2701965

18. Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Katja N. Gaarenstroom, Christiana A. Naaktgeboren, Toon van Gorp et al. 2017. Laparoscopy to predict the result of primary cytoreductive surgery in patients with advanced ovarian cancer: a randomized controlled trial. J Clin Oncol 35:613-621. https://doi.org/10.1200/JCO.2016.69.2962; PMid:28029317

19. Fleming ND, Nick AM, Coleman RL, Westin SN, Ramirez PT, Soliman PT, Fellman B, Meyer LA, Schmeler KM, Lu KH, Sood AK. 2018. Laparoscopic Surgical Algorithm to Triage the Timing of Tumor Reductive Surgery in Advanced Ovarian Cancer. Obstet Gynecol. Sep;132(3):545-554. https://doi.org/10.1097/AOG.0000000000002796; PMid:30095787 PMCid:PMC6105510

20. Van de Vrie R., Rutten M.J., Asseler J.D. 2019. Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009786.pub3; PMid:30907434