An Aggressive Approach to Ovarian Cancer Treatment?

Implementing a multidisciplinary team and intraoperative approach led to improvements in overall survival (OS), progression-free survival (PFS), and complete cytoreduction rates (CCR) in patients with ovarian cancer, according to a study published in the Annals of Surgical Oncology from researchers at Mater University Hospital, University College Dublin.¹

In 2017, the hospital began more aggressively operating on ovarian cancer tumors, collaborating between multiple surgical disciplines and focusing on removing all visible tumors from abdomens.² Investigators sought to report on changes in OS, PFS, and CCR in the 5 years after implementing a multidisciplinary surgical team.¹

“The impact of a multidisciplinary, surgical approach is in our opinion that it fosters a collaborative approach and facilitates the implementation of a more aggressive surgical philosophy in carefully selected patients,” study authors wrote.¹

Retrospective data from a previously published study of 146 patients treated for ovarian cancer between 2006 and 2015 made up the first cohort. The second cohort was 174 patients treated between 2017 and 2021 after a multidisciplinary surgical team was established. The median follow-up was 60 months in the first cohort and 48 months in the second.

The rate of primary cytoreductive surgery increased from the first cohort (38%; n = 55) to the second (46.5%; n = 81). Complete macroscopic resection also increased from the first cohort (58.9%; n = 86) to the second (78.7%, n = 137). At 3 years, 109 patients (75%) in the first cohort had disease progression compared with 85 patients (48.8%) in the second cohort (P <.001). Additionally, at 3 years, 93 patients (64.5%) in the first cohort had died compared with 42 patients (24%) in the second. Multidisciplinary team input, residual disease, and age were independent predictors of OS (HR, 0.29; 95% CI, 0.203-0.437; P <.001) and PFS (HR, 0.31; 95% CI, 0.21-0.43, P <.001), according to Cox multivariate analysis.

“Our study is one of the largest to date examining the impact of a multidisciplinary surgical approach as an independent predictor of progression-free and overall survival in advanced ovarian cancer,” study authors wrote. “The complete resection rates reported in cohort B are significantly higher than those reported in current literature and support a multidisciplinary, collaborative, surgical approach to advanced ovarian cancer,” study authors wrote.¹

This study is not the first to suggest a more aggressive surgical approach to ovarian cancer treatment. A study published in Proceedings of the National Academy of Sciences in 2021 found that patients with high-grade ovarian cancer who underwent complete debulking surgery before chemotherapy had better outcomes than those who had chemotherapy before surgery. However, the study also concluded that this approach may have limited benefit in patients with relapsed disease.³

REFERENCES:

1. Mulligan, K, Corry, E, Donohoe, F et al. Multidisciplinary surgical approach to increase survival for advanced ovarian cancer in a tertiary gynaecological oncology centre. Ann Surg Oncol (2023). [published online ahead of print 24 October 2023.] doi:0.1245/s10434-023-14423-1

2. Kearns, D. Ovarian cancer patients 70% less likely to die with aggressive surgical approach. News release. University College Dublin. October 27, 2023. Accessed November 2, 2023. https://tinyurl.com/zu6754tu

3. Gu S, Lheureux S, Sayad A, et al. Computational modeling of ovarian cancer dynamics suggests optimal strategies for therapy and screening. Proc Natl Acad Sci U S A. 2021;118(25):e2026663118. doi:10.1073/pnas.2026663118