Sugery for Ovarian Cancer

gdpawel

It is recommended that patients with ovarian cancer undergo aggressive de-bulking surgery up front, prior to chemotherapy. It has long been observed that those patients whose tumors can be resected without any visible residual disease tend to live longer than those who are left with residual tumor after de-bulking surgery. Based upon this, up front, de-bulking surgery has become the standard of care.

Some researchers believe the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive, and that the removal of lymph nodes at the time of surgery may additionally contribute to a better outcome.

A study from Germany tested the role of surgery in patients with recurrent ovarian cancer and found that those patients who underwent resection without any residual tumor did better than those whose tumors could not be completely removed. The authors of this study identified four parameters that could predict the possibility of complete resection, which included:

--Good performance status

--No ascites (malignant fluid in the abdomen)

--No residual tumor after the first surgery

--No evidence of peritoneal spread of tumor on the preoperative tests

Patients who met all these criteria had an 80 percent chance of successful surgery with complete tumor removal.

Surgery is an integral part of the multimodality treatment of many cancers. In the case of ovarian cancer, proper patient selection will ensure the benefit of surgery for those who need it and avoid its morbidity and delay in the commencement of chemotherapy for those who are unlikely to benefit from it.

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Full surgery superior to chemotherapy in recurrent cancer

Assessing the impact of secondary surgical cytoreduction on the survival of patients with recurrent ovarian cancer, compared with chemotherapy alone.

According to a recent article in Gynecologic Oncology, patients with recurrent ovarian cancer may have improved survival when treated with cytoreductive surgery compared to chemotherapy alone. However, patients who can have all of their visible cancer removed during surgery appear to gain the most benefit.

Complete surgical cytoreduction significantly lengthens survival of recurrent ovarian cancer patients, compared with salvage chemotherapy alone, reveal researchers who stress the need to assess tumor debulkability before surgery.

The possibility that secondary cytoreductive surgery may be beneficial to patients whose disease recurs with a disease-free interval of more than 6 months has been suggested by numerous authors, note Mete Gungor (Ankara University School of Medicine, Turkey) and colleagues.

To investigate, the team assigned 75 such patients to undergo salvage surgery (n = 44) or salvage chemotherapy alone (n = 31), and then followed them up for survival. A macroscopically complete surgical cytoreduction was achieved in 34 (77 percent) of the operated patients.

Survival was significantly longer in the women who were completely cytoreduced than in those who were incompletely cytoreduced and those who underwent chemotherapy (19 months vs 9 months and 12 months, respectively).

The researchers concluded that cytoreductive surgery may improve survival compared to chemotherapy alone in patients with recurrent ovarian cancer. Patients whose cancer is completely removed appear to achieve the greatest benefit from surgery. Future clinical trials are necessary to help determine specific patient and disease characteristics that are associated with optimal outcomes with cytoreductive surgery.

Source: Gynecologic Oncology 2005; 97: 74-79

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Surgery best option for ovarian cancer in diaphragm

In a retrospective study looking back at a decade of surgeries, Mayo Clinic Cancer Center researchers have determined that surgery to remove metastatic disease from the diaphragm, in conjunction with other procedures to remove the primary diseased tissue in ovarian cancer patients, significantly increases survival rates. Study results were published in Gynecologic Oncology online.

"Surgeons have long believed that removing as much diseased tissue as possible is important for survival of cancer patients," said William Cliby, M.D., associate professor of obstetrics and gynecology at Mayo Clinic. "The choice of many surgeons to not resect diaphragm disease in ovarian cancer patients seemed counterintuitive, but it was based on the feeling that it might not improve survival. We sought to address this issue."

Dr. Cliby's team cited lack of evidence of survival benefit, concerns over safety (related to complexity and length of the surgery) and lack of surgeon experience as justifications often given for not proceeding with diaphragmatic surgery in advanced ovarian cancer patients. Hoever, this study provided strong evidence of survival benefit. The five-year survival rates for patients with diaphragm disease who had optimal residual disease (less than 1 cm) was 55 percent for those undergoing diaphragm surgery versus 28 percent for those who did not.

The study group included 244 consecutive patients with primary ovarian cancer who were operated on at Mayo Clinic from 1994 through 1998 and from Aug. 1, 2002, through Aug. 31, 2004. Dr. Cliby and his colleagues found that at Mayo Clinic, the rate of diaphragm procedures for affected patients increased from 22.5 percent in the first period compared to 40 percent in the more recent period. They attribute this to increased surgeon experience, increased recognition of the importance of maximal effort for tumor resection and the cooperative working relationships with other surgical specialties at Mayo Clinic that provide the opportunity to train interdepartmentally and improve surgical techniques. "We hope to continue improving upon our ability to remove cancer disease from all affected areas," said Dr. Cliby. "With each operation, our surgeons become better equipped to handle the most difficult of surgeries, providing hope for more patients."

The researchers conclude that while health issues in some patients will complicate the success of surgery in general, and prevent the option of radical surgery, surgeons should work to increase the rate of tumor reduction, including diaphragm surgery, in appropriate cases.

mdunnk

gdpawel said:

Surgery best option for ovarian cancer in diaphragm

In a retrospective study looking back at a decade of surgeries, Mayo Clinic Cancer Center researchers have determined that surgery to remove metastatic disease from the diaphragm, in conjunction with other procedures to remove the primary diseased tissue in ovarian cancer patients, significantly increases survival rates. Study results were published in Gynecologic Oncology online.

"Surgeons have long believed that removing as much diseased tissue as possible is important for survival of cancer patients," said William Cliby, M.D., associate professor of obstetrics and gynecology at Mayo Clinic. "The choice of many surgeons to not resect diaphragm disease in ovarian cancer patients seemed counterintuitive, but it was based on the feeling that it might not improve survival. We sought to address this issue."

Dr. Cliby's team cited lack of evidence of survival benefit, concerns over safety (related to complexity and length of the surgery) and lack of surgeon experience as justifications often given for not proceeding with diaphragmatic surgery in advanced ovarian cancer patients. Hoever, this study provided strong evidence of survival benefit. The five-year survival rates for patients with diaphragm disease who had optimal residual disease (less than 1 cm) was 55 percent for those undergoing diaphragm surgery versus 28 percent for those who did not.

The study group included 244 consecutive patients with primary ovarian cancer who were operated on at Mayo Clinic from 1994 through 1998 and from Aug. 1, 2002, through Aug. 31, 2004. Dr. Cliby and his colleagues found that at Mayo Clinic, the rate of diaphragm procedures for affected patients increased from 22.5 percent in the first period compared to 40 percent in the more recent period. They attribute this to increased surgeon experience, increased recognition of the importance of maximal effort for tumor resection and the cooperative working relationships with other surgical specialties at Mayo Clinic that provide the opportunity to train interdepartmentally and improve surgical techniques. "We hope to continue improving upon our ability to remove cancer disease from all affected areas," said Dr. Cliby. "With each operation, our surgeons become better equipped to handle the most difficult of surgeries, providing hope for more patients."

The researchers conclude that while health issues in some patients will complicate the success of surgery in general, and prevent the option of radical surgery, surgeons should work to increase the rate of tumor reduction, including diaphragm surgery, in appropriate cases.

I am receiving radiation treatments to my diaphragm which is a fairly new technology that has opened in the last couple of months. Do you have any info on radiaiton treatments vs surgery to the diahragm?

gdpawel

mdunnk said:

I am receiving radiation treatments to my diaphragm which is a fairly new technology that has opened in the last couple of months. Do you have any info on radiaiton treatments vs surgery to the diahragm?

During my research of three types of treatments for cancer (surgery, chemo, radiation), I haven't come across any information on radiation versus surgery for the diaphragm. However, one can only surmise the side effects from looking at studies of radiation effects on various other organs.

Men who get radiation treatment for prostate cancer are 70% more likely to develop rectal cancer than those who are treated with surgery only, according to a new study in the journal Gastroenterology (Vol. 128, No. 4:819-824).

When irradiation exceeds tolerated doses, inflammation of the lung is seen from one to three months after treatment. The process can be lethal when both lungs are involved or if threshold doses of chemotherapy (if used) have been exceeded. Recovery from the acute phase usually occurs and the second phase follows almost immediately. Eventually, progression to the late fibrotic stage occurs. Radiation pneumonitis should be prevented. Corticosteroids can aid in recovery from acute pneumonitis. Antibiotics for infection and supplemental oxygen may be needed. (Pazdur et al, 2003)

Pulmonary fibrosis or radiation fibrosis is scarlike changes in healthy lung tissue caused by irradiation to the chest, a serious side effect. Fibrosis is an inflammatory condition that causes progressive scarring to healthy tissue. It can develop insidiously in the previously irradiated area and usually stabilizes after one to two years. Most patients may have no symptoms if the fibrosis is limited to half of one lung. Pulmonary fibrosis caused by radiation therapy is irreversible. Management consists of supportive measures such as oxygen, bronchodilators and ipratropium bromide. (Teeley and Bashe, 2000)

Radiation enteritis is a malfunction of the large and small bowel that occurs during or after radiation therapy to the abdomen, pelvis, or rectum. The large and small bowel are very sensitive to radiation. The amount of damage to normal tissues increases as the radiation dose increases and since larger doses are needed for most tumors in the abdomen and pelvis, enteritis is likely to occur.

My wife experienced surgical excision to a transdiaphragmatic tumor from her original ovarian cancer (twenty-four years earlier), with attachment to the lung and other midline structures of the chest. Parts of those structures were surgically resected. The thoracic surgical oncologist state that she was 100% successful and did not feel that further treatment with chemotherapy was indicated. My wife had excellent recovery and for the next seven months, had an exceptional life style, free of disease.