Abstract
Purpose
This study was designed to compare quality of life in a sample of Italian patients affected by platinum-sensitive recurrent ovarian cancer and submitted to chemotherapy alone or secondary cytoreductive surgery plus chemotherapy through validated questionnaires.
Methods
From January 2007 to December 2012, consecutive patients with suspicious recurrence of ovarian cancer, referred to the Division of Gynecologic Oncology at the University Campus Bio-Medico of Rome, were assessed for this prospective, case-control study. After a diagnostic laparoscopy, surgical resectable patients were enrolled in group A (surgery plus chemotherapy). Patients not suitable for optimal debulking surgery and all patients who refused surgery were enrolled in group B (chemotherapy alone). At beginning of treatment, after the third and sixth cycle of chemotherapy, all eligible patients were asked to fill in QLQ-C30 (version 3.0) and EORTC QLQ-OV28 questionnaires.
Results
Group A included 38 patients and underwent SCS followed by chemotherapy; group B included 16 patients that were submitted to chemotherapy alone. Quality-of-life scores of both questionnaires were comparable between groups, with the exception of constipation and pain, which resulted significantly worsened in Group A at 3 months. This difference was no longer present at 6 months. Median overall survival was 72 % for Group A and 56 % in Group B at median follow-up of 35 months for Group A and 32 months for Group B.
Conclusions
Both surgery followed by chemotherapy and chemotherapy alone seem to have a negligible impact on QOL. SCS plus chemotherapy seems to be an effective and tolerable therapeutic option in platinum-sensitive recurrences.
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References
American Cancer Society. Cancer facts and figures 2013. Atlanta: American Cancer Society, 2013.
Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.
Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the ovary. Int J Gynecol Obstet. 2003;83(Suppl):135–66.
Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol. 2009;112:265–74.
Al Rawahi T, Lopes AD, Bristow RE. Surgical cytoreduction for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev. 2013;28:2.
Angioli R, Palaia I, Zullo MA, et al. Diagnostic open laparoscopy in the management of advanced ovarian cancer. Gynecol Oncol. 2006;100:455–61.
Dindo D, Dematrtines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and result of a survey. Ann Surg. 2004;240:205–13.
World Health Organization. WHO handbook for reporting results of cancer treatment (offset publication no. 48). Geneva: World Health Organization; 1979:16–21.
Bjordal K, deGraeff A, Fayers PM, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (The EORTC QLQ-H&N35). Eur J Cancer. 2000;36:213–9.
Greimel E, Bottomley A, Cull A, et al; EORTC Quality of Life Group and the Quality of Life Unit. An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-OV28) in assessing the quality of life of patients with ovarian cancer. Eur J Cancer. 2003;39:1402–8. Published correction appears in Eur J Cancer. 2003;39(17):2570.
Scott NW, Fayers PM. The EORTC QLQ_C30 scoring manual. 3rd edn. Brussels: European Organisation for Research and Treatment of Cancer; 2001.
Gadducci A, Lacconi P, Cosio S, et al. Complete salvage surgical cytoreduction improves further survival of patients with late recurrent ovarian cancer. Gynecol Oncol. 2000;79(3):344–9.
Gungor M, Ortac F, Arvas M, et al. The role of secondary cytoreductive surgery for recurrent ovarian cancer. Gynecol Oncol. 2005;97(1):74–9.
Harter P, du Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial. Ann Surg Oncol. 2006;13(12):1702–10.
Munkarah AR, Coleman RL. Critical evaluation of secondary cytoreduction in recurrent ovarian cancer. Gynecol Oncol. 2004;95(2):273–80.
Santillan A, Karam AK, Li AJ, et al. Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer. Gynecol Oncol. 2007;104:686–90.
Tebes SJ, Sayer RA, Palmer JM, et al. Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol. 2007;106(3):482–7.
Galaal K, Naik R, Bristow RE, et al. Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev. 2010; (6).
Friedlander M, Trimble E, Tinker A, et al. Clinical trials in recurrent ovarian cancer. Int J Gynecol Cancer. 2011;21:771–5.
Stuart GC, Kitchener H, Bacon M, et al. 2010 Gynecologic Cancer InterGroup (GCIG) consensus statement on clinical trials in ovarian cancer: report from the Fourth Ovarian Cancer Consensus Conference. Int J Gynecol Cancer. 2011;21(4):750–5.
Cella D. What do global quality-of-life questions really measure? Insights from Hobday et al and the “do something” rule. J Clin Oncol. 2003;21(16): 3178–9.
WHO. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Qual Life Res. 1993;2(2):153–9.
Angioli R, Plotti F, Aloisi A, et al. Does extensive upper abdomen surgery during primary cytoreduction impact on long-term quality of life? Int J Gynecol Cancer. 2013;23(3):442–7.
Angioli R, Plotti F, Cafà EV, et al. Quality of life in patients with endometrial cancer treated with or without systematic lymphadenectomy. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):539–43.
Coates A, Porzsolt F, Osoba D. Quality of life in oncology practice: prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy. Eur J Cancer. 1997;33:1025–30.
Eton D, Fairclough D, Cella D, et al. Early change in patient-reported health during lung cancer chemotherapy predicts clinical outcomes beyond those predicted by baseline report: results from Eastern Cooperative Oncology Group Study 5592. J Clin Oncol. 2003;21:1536–43.
Coates A, Gebski V, Signorini D, et al. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer: Australian New Zealand Breast Cancer Trials Group. J Clin Oncol. 1992;10:1833–8.
Dancey J, Zee B, Osoba D, et al. Quality of life scores: an independent prognostic variable in a general population of cancer patients receiving chemotherapy. Qual Life Res 1997;6:151–8.
Sugarbaker PH, Barofsky I, Rosenberg SA, et al. Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery. 1982;91:17–23.
Blazeby JM, Avery K, Sprangers M, et al. Health-related quality of life measurement in randomized clinical trials in surgical oncology. J Clin Oncol. 2006;24:3178–86.
Zamurovic M. Ovarian carcinoma patients–life quality analysis in the postoperative period. How to improve it? Eur J Gynaecol Oncol. 2010;31(6):672–4.
Woelber L, Jung S, Eulenburg C, et al. Perioperative morbidity and outcome of secondary cytoreduction for recurrent epithelial ovarian cancer. Eur J Surg Oncol. 2010;36:583–8.
Vernooij F, Heintz AP, Coebergh JW, et al. Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands. Gynecol Oncol. 2009;112:455–61.
Bristow RE, Palis BE, Chi DS, et al. The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol. 2010;118:262–7.
Harter P, Sehouli J, Reuss A, et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer. 2011;21:289–95.
Tian WJ, Chi DS, Sehouli J, et al. A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: an evidence-based proposal for patient selection. Ann Surg Oncol. 2012;19:597–604.
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Plotti, F., Scaletta, G., Aloisi, A. et al. Quality of Life in Platinum-Sensitive Recurrent Ovarian Cancer: Chemotherapy Versus Surgery Plus Chemotherapy. Ann Surg Oncol 22, 2387–2394 (2015). https://doi.org/10.1245/s10434-014-4263-8
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DOI: https://doi.org/10.1245/s10434-014-4263-8