BUFFALO, NYSurvival in patients with ovarian cancer by stage is
similar to that of other cancers, William Hoskins, MD, said at the
Surgical Oncology Symposium, hosted by Roswell Park Cancer Institute.
However, the vast majority of women are diagnosed with advanced
disease, and there are no screening methods available to change this
truth. Until screening methods improve, the surgical treatment
offered these women is critical to their survival, said Dr.
Hoskins, chief, Gynecology Service, Memorial Sloan-Kettering Cancer
Women are offered cytoreductive surgery to decrease the primary tumor
volume and increase the sensitivity of their remaining tumor cells to
chemotherapyin essence, to force the cells back into an active
growth phase by debulking the tumor.
The amount of residual disease left after the primary surgery
has an impact on survival, Dr. Hoskins said. If a surgeon
cant reduce the tumor burden to less than 2 cm, then it
doesnt matter. Survival can only be affected by decreasing the
primary tumor to 0 cm to 2 cm.
Overall survival in ovarian cancer has improved with the use of new
chemotherapy agents in the past 20 years, he said, including the
platinum drugs and the addition of paclitaxel (Taxol), which has the
potential of decreasing the risk of dying of ovarian cancer by 28%.
When women return with symptoms after initial therapy, the
second-look surgery becomes critical, Dr. Hoskins said. Salvage
therapy may be able to achieve significant responses in 20% to 35% of
women with recurrent ovarian cancer.
We also see that chemotherapy resistance from the first round
of treatments will decrease over time, which may help with secondary
therapies, he added.
Trials are needed to determine which agents work for patients who
have developed resistance and which combinations may work up front to
minimize the problem of resistance, Dr. Hoskins said. Additional
research is also needed to establish the role and timing of interval
cytoreduction and the potential role of preoperative chemotherapy to
shrink the tumor and treat micrometastases.