SEARCH · PubMed Health

Results for “Interval debulking surgery”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

14 recordsLinked to original sources

PubMed2026

[Effect of Cancer Antigen-125 Elimination Rate Constant K and BRCA Mutation Status on the Prognosis of Interval Debulking Surgery in Advanced High-Grade Serous Ovarian Cancer].

OBJECTIVE: To investigate the predictive value of the cancer antigen-125 elimination rate constant K (KELIM) for treatment response and prognosis in patients with advanced high-grade serous ovarian cancer (HGSOC) undergoing neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS), and to analyze the combined prognostic significance of KELIM and the mutation status of breast cancer susceptibility gene (BRCA). METHODS: A total of 106 patients with advanced HGSOC who had undergone NACT-IDS were retrospectively enrolled. The KELIM values during neoadjuvant chemotherapy were calculated, and patients were divided into high- and low-KELIM groups using a cutoff value of 1.0. Clinicopathological characteristics, R0 resection rates, and platinum sensitivity rates were compared between the two groups. Logistic regression analysis was performed to identify predictive factors for R0 resection, while Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to evaluate factors associated with progression-free survival (PFS). Furthermore, the patients were stratified according to both KELIM and BRCA status to assess the risk of platinum-resistant recurrence in each subgroup. RESULTS: The R0 resection rate was higher in the KELIM ≥ 1 group than in the KELIM < 1 group (77.1% vs 55.2%), and the difference was statistically significant (P = 0.024). Multivariate logistic regression analysis showed that KELIM was an independent predictor of R0 resection (odds ratio [OR] = 2.922, 95% CI: 1.112-7.678). Survival analysis demonstrated longer PFS in the KELIM ≥1 group compared with that in the KELIM <1 group (33.0 months vs 18.0 months), and the difference was statistically significant (P < 0.001). Multivariate Cox regression analysis showed that KELIM ≥ 1 was associated with a reduced risk of disease progression (hazard ratio [HR] = 0.481, 95% CI: 0.280-0.826). Combined stratification analysis revealed that no platinum-resistant recurrence was observed in the subgroup with both KELIM ≥1 and a BRCA-positive status (0/21). Compared with patients with KELIM <1 and a BRCA-negative status, this subgroup exhibited a lower risk of platinum-resistant recurrence (OR = 0.053, 95% CI: 0.003-0.932, P = 0.006). CONCLUSION: KELIM is an effective dynamic biomarker for predicting surgical outcomes and PFS in patients undergoing NACT-IDS. Combined stratification by KELIM and BRCA status allows more precise identification of the patient population with both KELIM ≥1 and BRCA-positive status, who have an extremely low risk of platinum-resistant recurrence, thereby providing an important basis for individualized treatment and risk stratification management in patients with advanced HGSOC.

Humans↗

PubMed1991

Neoadjuvant chemotherapy and interval debulking for advanced epithelial ovarian cancer.

A retrospective matched-control study was conducted to review our experience with FIGO stage III and IV epithelial ovarian cancer in patients referred after initial laparotomy and biopsy only. The study group comprised 22 patients; planned treatment was two to four cycles of chemotherapy, interval debulking surgery, six more chemotherapy cycles, and second-look laparotomy. Two control groups were matched with the study group according to FIGO stage, histologic type, and grade (2 or 3) and patient age +/- 5 years. The first control group (22 patients) had greater than 2 cm residual disease after initial surgery; their planned treatment was a minimum of six cycles of chemotherapy plus second-look laparotomy. The second control group (18 patients) was referred after initial laparotomy and biopsy only; their disease was immediately reexplored and debulked. Subsequent planned treatment was a minimum of six cycles of chemotherapy plus second-look laparotomy. All patients received cisplatin-based chemotherapy. Optimal cytoreduction to less than or equal to 2 cm was achieved for 77% of the study group vs 39% of the immediate-reexploration group (P = 0.02). Median survival times for the three groups were not different (16 vs 19.3 vs 18 months, respectively) (P = 0.58). Within the study group, patients who were optimally debulked survived significantly longer than those who were not (18.1 vs 7.5 months) (P = 0.02). Morbidity of the interval debulking procedure was acceptable. Study findings suggest that patients with bulky residual disease have a uniformly poor prognosis regardless of the timing of further surgery.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1989

Neoadjuvant (cytoreductive) chemotherapy combined with intervention debulking surgery in advanced, unresected epithelial ovarian cancer.

Thirty-six patients with epithelial ovarian cancer, incompletely resected at primary laparotomy, were treated with one of two intensive cis-platinum-based combination chemotherapy regimens. The intention was to perform further surgical debulking (intervention debulking surgery) after three cycles in patients responding to treatment. Intervention debulking surgery was carried out in 28 of 36 patients (78%) at a median interval of 12.7 weeks from primary diagnosis. Omentectomy and total abdominal hysterectomy were the most commonly performed procedures at intervention debulking. As a result of such surgery, 16 of the 28 women (57%) were left with no macroscopic residual disease, five (18%) had less than 1 cm, four (14%) less than 2 cm residuum, and three (11%) remained with more extensive disease. Post-intervention debulking surgical complications were few, with a median postoperative hospital stay of 10 days and a median interval of 21 days from debulking surgery to resumption of chemotherapy. Neoadjuvant (cytoreductive) chemotherapy combined with early secondary surgical debulking is feasible, with little severe morbidity, and can leave a high proportion of patients free of macroscopic disease. The effect of such a program on patient survival is now being tested in a randomized study.

Adult↗

PubMed1992

Cytoreductive surgery in the treatment of advanced ovarian carcinoma. Some controversial aspects.

Primary cytoreductive surgery in the treatment of advanced ovarian carcinoma is widely accepted and practiced. Its value has however never been established by controlled trials and the concept is therefore not unchallenged. Data with regard to the benefit of interval and secondary debulking are limited and often conflicting. Prospective randomized studies specifically designed to elucidate the controversies relevant to cytoreductive surgery are warranted.

Carcinoma↗

PubMed1990

Anaplastic thyroid carcinoma. Doxorubicin, hyperfractionated radiotherapy and surgery.

Sixteen consecutive patients with anaplastic carcinoma of the thyroid were prospectively treated according to a combined regimen consisting of hyperfractionated radiotherapy, doxorubicin and debulking surgery. The radiotherapy was preoperatively administered to a target dose of 30 Gy in 3 weeks, and postoperatively to an additional dose of 16 Gy in 1.5 weeks. Radiotherapy was administered twice daily, 5 days a week, with a target dose of 1 Gy per fraction and with a minimum interval of 6 hours. A dose of 20 mg doxorubicin was administered intravenously 1 to 2 hours before the first radiotherapy session every week. Debulking surgery was feasible in 9 patients. Local complete remission was achieved in 5 patients and 3 of these are still alive disease-free at 10, 30, and 30 months respectively after diagnosis. Only 6 patients succumbed to a local failure. This combination regimen was well tolerated despite the patients' high age and advanced disease.

Aged↗

PubMed1992

Favorable response of metastatic adrenocortical carcinoma to etoposide, adriamycin and cisplatin (EAP) chemotherapy. Report of two cases.

The usefulness of non-specific chemotherapy for advanced adrenocortical carcinoma (ACC) is controversial. We report on 2 young female patients (25 and 19 yr) who presented with a clinical picture of Cushing's syndrome due to histologically confirmed ACC. The first patient underwent radical surgery, but after a disease-free interval of 6 months a local recurrence was apparent. She was reoperated and treated with 6 courses of cisplatin and etoposide chemotherapy. Mitotane (8 g daily) was begun, but 2 months later debulking surgery was again performed. A second-line chemotherapy with the etoposide, adriamycin, cisplatin (EAP) scheme attained a partial remission lasting 7 months, then metastatic spread to the brain led to death of the patient. The survival time was 30 months. The second patient underwent radical surgery and adjuvant mitotane (4 g daily), but multiple lung and mediastinal metastases were diagnosed after an interval of 29 months. Chemotherapy with the EAP regimen (6 courses) without interrupting mitotane attained a partial remission lasting 21+ months. We suggest that the EAP scheme is active in advanced ACC and that its association with mitotane is feasible.

Adrenal Cortex Neoplasms↗

PubMed1988

The role of surgical reexploration following chemotherapy in ovarian cancer.

Two hundred and eighty three patients with FIGO Stages III-IV ovarian epithelial cancer were entered on a randomized trial of chlorambucil with or without cisplatin. Eighty two of these patients have subsequently undergone surgical reexploration. Ten of these were for surgical indications (intestinal obstruction, etc.), and 7 were interval reexplorations at about 6 months on patients who had not been adequately debulked at primary surgery. The remaining 65 patients had elective operations after 12 months chemotherapy, and in 52 of these there was no pre-operative clinical evidence of residual disease. Complete Surgical Response rate (CRS) was similar in the 2 treatment arms (8% v 9.7%); 42.3% of patients in apparent remission at 12 months had negative reexploration and 57.5% of these were alive after 4 years (post-reexploration median survival greater than 4 1/2 years). The remaining 57.7% of patients had residual disease at reexploration and their 4-year survival was 15% (median survival 73 weeks). A further group of 13 patients had 'responding' and probably resectable residual disease at 12 months. These patients were reexplored with a view to secondary debulking. Their 4-year postoperation survival was 15% (median survival, 70 weeks). There were 9 patients who, though in apparent remission at 12 months, were not subjected to surgical reexploration. The median survival for this group was 33 weeks, calculated from the mean theoretical time when they should have had reexploration. This was significantly inferior to the results for the 52 patients, also in apparent remission, who underwent reexploration (4-year survival 32.5%, median survival 123 weeks, p = 0.002).

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1989

The influence of cytoreductive surgery on progression-free interval and survival in epithelial ovarian cancer.

In 1980, Dr George E. Moore published an editorial in Surgery, Gynecology and Obstetrics entitled 'Debunking debulking'. He included advanced ovarian cancer in his personal list of 'faulty' debulking procedures. Some of hist statements have merit. He contends that overly aggressive procedures that leave microscopic tumour cells that will soon grow and kill the patient are unindicated. He further points out that one cubic centimetre of tumour will contain approximately a billion cells. However, there are factors in ovarian cancer that should cause one to take exception to Dr Moore's statement. First, there is good evidence that the use of cisplatin-based multidrug chemotherapy may eradicate microscopic tumour deposits in a significant number of patients. Secondly, even multiple aggregates of tumour with a billion or more cancer cells can be eradicated in some cases, and in others can be reduced sufficiently to allow significant palliation. In evaluating the information which has been reviewed in this discussion of cytoreductive surgery for advanced ovarian cancer, it is apparent that cytoreductive surgery is not only indicated, but mandated in many facets of the management of ovarian cancer. The following principles seem to be supported by the existing literature: 1. Current diagnostic techniques do not enable us to diagnose ovarian cancer while still confined to the ovary. Therefore, in the immediate future we will still encounter a large number of patients with advanced disease. 2. The number of complete clinical responses and the number of complete pathological responses (negative second-look surgical reassessments) are greatest in those patients who begin adjunctive therapy with minimal residual disease. 3. Median duration of survival is longer, and long-term survival more likely, in those patients giving complete clinical or complete pathological responses. 4. Some patients appear to benefit from secondary cytoreductive surgery. However, at the present time, evidence of benefit from secondary cytoreductive surgery appears to be limited to those patients who have responded to adjunctive therapy and are found to have residual disease at surgical reassessment. There is no good evidence to support secondary cytoreductive surgery as an 'interval' procedure or its use in patients with progression on primary adjunctive therapy. This development of better chemotherapy regimens, such as cisplatin-based chemotherapy, has resulted in a greater need for effective primary cytoreductive surgery as it is apparent that, on utilizing these new regimens, better results are obtained in patients with minimal residual disease.(ABSTRACT TRUNCATED AT 400 WORDS)

Carcinoma↗

PubMed1990

Feasibility and outcome of complete secondary tumor resection for patients with advanced ovarian cancer.

From November 1981 to July 1985, 124 women with International Federation of Gynecology and Obstetrics (FIGO) stage III ovarian cancer were treated in prospective studies of surgery and chemotherapy in our institution. Patients with no macroscopic cancer after primary surgery (n = 16) received five cycles of adjuvant cis-platinum; those with residual cancer after primary laparotomy (n = 108) underwent a second surgical debulking after three or five cycles of cis-platinum-based cytoreductive chemotherapy. Total macroscopic tumor clearance was achieved in 26 of these 108 patients. Fourteen patients with total tumor excision at primary laparotomy remain in complete clinical remission a minimum of 36 months after diagnosis, but the median progression-free interval for the other two groups was 9 and 17 months, respectively. The survival for women who have total tumor clearance only at secondary surgery after chemotherapy is inferior to that for women with primary macroscopic tumor excision followed by chemotherapy.

Adult↗

PubMed1992

Carboplatin/cyclophosphamide combination chemotherapy for advanced ovarian cancer.

The efficacy and toxicity of combination intravenous carboplatin (300 mg/m2) and cyclophosphamide (600 mg/m2) were evaluated in 70 newly diagnosed patients with advanced-stage epithelial ovarian cancer. Cycles were administered at 4-week intervals for a total of six cycles, and treatment was provided on an outpatient basis without prehydration or forced diuresis. During treatment, patients were assessed by physical, gynecologic, and radiologic examinations. Seventy patients with a median age of 58 years (range, 35 to 77 years) were entered into the study. Most patients had serious cystadenocarcinoma; 78% had stage III or IV disease and 91% had grade II or III histologic subtype. Optimal debulking surgery was performed in only 46% of patients. The overall response rate to carboplatin/cyclophosphamide combination chemotherapy was 81%, with 66% achieving a clinical complete response. The median survival for all patients was 19+ months. For patients who had undergone optimal debulking surgery, median survival was 26 months, compared with a median survival of 13+ months for those who had undergone suboptimal surgery. Treatment was well tolerated by most patients. Significant nausea and vomiting (World Health Organization grades 2 to 3) occurred in only 6% of 377 cycles of therapy. Myelosuppression was mild, with leukopenia (WBC count less than or equal to 2 x 10(9)/L) observed in only 11 of 295 cycles (4%) and thrombocytopenia (less than or equal to 100 x 10(9)/L) in 17 of 279 cycles (6%). Nadir levels generally occurred on day 21 of each cycle. Symptomatic anemia requiring transfusion occurred in 18 of 290 cycles (6%). Moderate alopecia, necessitating use of a hairpiece, occurred in six patients; no signs or symptoms of neurotoxicity, ototoxicity, or nephrotoxicity were observed in any patient. Renal function was normal on follow-up investigation, which was performed a median of 5 months after completion of treatment. This study demonstrates that carboplatin/cyclophosphamide combination chemotherapy is well tolerated in women with advanced-stage epithelial ovarian cancer, and produces overall response rates and median survival times similar to those obtained with cisplatin-containing regimens.

Adult↗

PubMed1990

Phase II study of carboplatin and cyclophosphamide combination chemotherapy for the treatment of advanced ovarian cancer.

The efficacy and toxicity of intravenous carboplatin (300 mg/m2) and cycloprosphamide (600 mgs/m2) was evaluated in 44 newly diagnosed patients with advanced stage epithelial ovarian cancer. Cycles were administered at four weekly intervals for a total of 6 cycles, and therapy was provided on an out-patient basis without prehydration or forced diuresis. During treatment patients were assessed by physical, gynaecological and radiological examinations. Forty-four patients with a median age of 54 years (range 28-76) were entered into the study. The majority of patients had serous cystadenocarcinoma, 82% had stage III or IV disease and 87% had grade II or III histologic subtype. Optimal debulking surgery was carried out in only 46% of patients. The overall response rate to carboplatin/cyclophosphamide was 73%, with 55% achieving a clinical complete response. The median survival for all patients was 18+ months (range 2-41+). For those patients who received optimum surgery, median survival was 26+ months, compared with 11+ months for those whose lesion could not be completely resected. Treatment was well tolerated by most patients, with significant nausea and vomiting (WHO grade III-IV) observed in only 11% of 226 cycles of therapy. Myelosuppression was acceptale, with a mean nadir white cell count 4.3 x 10(9)/L (range 1.4-9.0) and a mean nadir platelet count of 273 X 10(9)/L (range 39-536) observed on day 21. There were no therapy-related infective episodes. Significant alopecia developed in 4 patients, but significant nephrotoxicity, ototoxicity or neurotoxicity has not been observed in any patients. This study demonstrates that combination carboplatin/cyclophosphamide is well tolerated in women with advanced stage epithelial ovarian cancer and produces overall response rates and median survival similar to those obtained with cisplatin-containing chemotherapy.

Adult↗

PubMed1992

Adjuvant therapy with intraperitoneal chromic phosphate (32P) in women with early ovarian carcinoma after comprehensive surgical staging.

From 1974-1990, 23 women with stage I and five with stage II epithelial ovarian carcinoma received intraperitoneal chromic phosphate (32P) as the only form of adjuvant therapy after complete debulking and comprehensive surgical staging laparotomy. Surgery consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, peritoneal washings for cytology, multiple biopsies of pelvic and abdominal peritoneum, and selective pelvic and para-aortic lymphadenectomy. Intraperitoneal 32P therapy was administered a median of 7 days after laparotomy. Significant toxicity was minimal; none of these patients required surgery for bowel obstruction. Overall 5-year survival was 90 and 100%, but disease-free survival was only 65% (95% confidence interval [CI] 36-86%) and 60% (95% CI 12-81%) for patients with stage I and II disease, respectively. Two patients developed intraperitoneal and six systemic relapses; all patients received cisplatin regimens after relapse. Univariate analysis of age, stage, histology, Ovarian Cancer Study/Gynecologic Oncology Group risk status, lesion size, and presence or absence of capsular adhesions revealed that only an age of 50 or more years had an adverse effect on disease-free survival (P less than .03). This study suggests that determination of early-stage disease and host-tumor biology may be the most important factors in determining the survival of women with early ovarian cancer defined by comprehensive surgical staging. Intraperitoneal 32P does not appear to be effective adjuvant therapy in these women.

Adult↗

PubMed1989

Treatment of advanced epithelial ovarian cancer with cisplatin and cyclophosphamide.

Between June 1981 and June 1984, 50 patients with stage III or IV epithelial ovarian cancer underwent initial surgery followed by combination chemotherapy with cisplatin 50 mg/m2 iv and cyclophosphamide 500-1000 mg/m2 iv at 28-day intervals. No patients with borderline or well-differentiated tumors were included. If patients were clinically disease-free after 12 cycles of therapy, a second-look laparotomy was performed. A complete response was noted in 12 patients (24%), 11 of whom were surgically evaluated. A partial response was noted in 4 patients (8%), 3 of whom were surgically evaluated. Thirty-four patients (68%) had no response to therapy. The median progression-free survival (PFS) for the entire group was 19.8 months, with a median survival of 27 months. Patients with less than or equal to 2 cm residual disease had a superior median PFS (25.4 months vs 18 months) and median survival (29.4 months vs 19.5 months) to those patients with greater than 2 cm residual disease. Patients who underwent primary debulking had a longer median survival than patients who underwent "interval" debulking after two to four cycles of chemotherapy (29.2 months vs 17.3 months). Thirteen patients (26%) are alive without evidence of disease, 4 patients are alive with disease, and 33 patients are dead of disease. Toxicity was very moderate. In summary, the activity and toxicity of the combination of cisplatin and cyclophosphamide compare favorably to other cisplatin combination regimens.

Adult↗

PubMed1992

Surgery for disseminated abdominal sarcoma.

Seventy-two consecutive patients with disseminated soft tissue sarcoma in the abdomen were prospectively placed in a program of debulking surgery. The tumor was completely resectable in 64% of the patients. Following the first exploration, the median survival was 23 months for those with resection of metastases and 9 months for those without resection (p less than or equal to 0.01); the former group had a survival rate of 28% at 3 years, 18% at 4 years, and 4% at 5 years (44%, 37%, and 10%, respectively, for low-grade sarcomas, i.e., grade I or II sarcomas), whereas in the latter group, none survived for 3 years. In the group with resection, patients with grade III tumors had a median survival longer by 6 months, and those with low-grade tumors by 28 months (p less than or equal to 0.001), over the respective median survival of patients with unresectable tumors. Metastasectomy appeared to prolong survival in all patients and significantly so in patients with low-grade tumors and those with long disease-free intervals.

Abdominal Neoplasms↗