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 "I do think this study will decrease the number" of such surgeries
that now appear to be unnecessary for many women, said Dr. Robert
Coleman of the University of Texas M.D. Anderson Cancer Center in
Houston, Texas, lead author of the study published in the New
England Journal of Medicine.
The operations are currently considered standard medical care. But
the new findings suggest that women who get chemotherapy alone if
their tumor reappears do as well or better than women who received
surgery before their chemotherapy.
The results only apply to women whose tumors are sensitive to
platinum-based drugs.
After a median follow-up period of 48.1 months, median overall
survival was 50.6 months for women with recurrent ovarian cancer who
got surgery and chemotherapy and 64.7 months for those who got only
chemotherapy.
That corresponded to a 29% increase in the death rate for the
surgery recipients.
About 22,500 women in the U.S. develop ovarian cancer each year,
according to the American Cancer Society. But more than 80% of women
have their disease recur, the 10-year survival rate is below 15%,
and roughly 14,000 are expected to die from their tumors. Roughly
half of affected women have platinum-sensitive tumors. About one
quarter of patients are candidates for secondary surgery if their
tumor recurs.
The trial, known as GOG-0213, ended early when preliminary results
showed that surgery was not helping. The volunteers had recurrent
epithelial ovarian, primary peritoneal, or Fallopian-tube cancer.
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Coleman told Reuters Health in a phone interview that the findings
were surprising, but the effectiveness of secondary surgery had not
been tested, and the results probably reflect the fact that
chemotherapy for ovarian cancer has improved significantly.
The women in the trial "ended up living three times longer than when
we started the trial," said Coleman, who is executive director of
cancer network research at M.D. Anderson.
Sixty-seven percent of the patients in the surgery group survived
for three years versus 74% who only got chemotherapy.
"Patient-reported quality of life decreased significantly after
surgery but did not differ significantly between the two groups
after recovery," the study team writes. The two groups reached
parity on the quality of life measure by the six-week mark.
Coleman said M.D. Anderson and other cancer centers have stopped
doing routine secondary surgery in the wake of the findings, but it
may take time for other medical centers to follow suit.
"There are definitely doctors out where who feel that, even though
the trial did not show a benefit, in their hands and in their
specific patients, there's a benefit, and a lot of patients would
want it," he said. "Most people, when they see cancer, they want it
out."
SOURCE: https://bit.ly/33CobKG The New England Journal of Medicine,
online November 13, 2019.
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