1. 10 Minutes Talk 吳 華 席 Hua-Hsi Wu, MD OB/GYN, VGH-TPE Sep 08, 2008

2. The role of 2nd debulking in 1st relapsed Ov Ca

3. Introduction  Epithelial ovarian carcinomas  the majority of deaths from gynecologic malignancies.  〜 70% newly diagnosed  advanced disease  80% after OP+T/P  complete clinical remission  75% of them  recurrence  Platinum sensitive (PFI > 6M)  combination C/T: Platinum/Taxol or Platinum/ Gemzar  Platinum-resistant  Single agent C/T: Lipo-dox, topotecan, or Gemzar

4. The role of 2nd debulking in 1st relapsed Ov Ca Clinical remission after 2nd line C/T 1. Unlike the high complete response rate after aggressive 1st-line C/T 2. Directly correlated with PFI 3. Shorter than previous one in 94% of cases 4. It may be possible to improve the chance of complete response and/or duration of second remission by adding 2nd cytoreductive (SCR) surgery to chemotheapy.

5. The role of 2nd debulking in 1st relapsed Ov Ca 2nd debulking  Many reports  clear survival benefit  Most retrospective  Outcome  PFI, volume of relapsed disease, residual tumor (primary or secondary)  Clinical optimal cytoreduction (COC)  associated with ascites, performance status, stages, number of cycle and type of salvage chemotherapy, and CA125 values.

6. The role of 2nd debulking in 1st relapsed Ov Ca The aim of this study  To investigate the benefit of SCR  To define criteria for selecting patients most likely benefit from SCR

7. The role of 2nd debulking in 1st relapsed Ov Ca Patients and Methods A retrospective population-based study on recorded information from 789 patients treated at the Norwegian Radium hospital during 1985-2000 for their initial recurrence. In all, 217 had SCR and 572 were treated with chemotherapy alone.

8. The role of 2nd debulking in 1st relapsed Ov Ca Results

9. The role of 2nd debulking in 1st relapsed Ov Ca

11. Copyright restrictions may apply. Oksefjell, H. et al. Ann Oncol 2008 0:mdn591v1-591; doi:10.1093/annonc/mdn591 Overall survival for patients with relapse of epithelial ovarian cancer for different treatment: no surgery, surgery for localized disease and surgery for disseminated disease (P < 0.01)

12. The role of 2nd debulking in 1st relapsed Ov Ca Copyright restrictions may apply. Oksefjell, H. et al. Ann Oncol 2008 0:mdn591v1-591; doi:10.1093/annonc/mdn591 Overall survival for patients after surgery for relapse of epithelial ovarian cancer and radicalism of the secondary cytoreduction (P < 0.01)

13. The role of 2nd debulking in 1st relapsed Ov Ca Copyright restrictions may apply. Oksefjell, H. et al. Ann Oncol 2008 0:mdn591v1-591; doi:10.1093/annonc/mdn591 Overall survival for patients after surgery for relapse of epithelial ovarian cancer and treatment- free interval (TFI) (P < 0.01)

14. The role of 2nd debulking in 1st relapsed Ov Ca Result  Complete optimal cytoreduction was achieved in 35% of all 217 patients  Residual disease after SCR, treatment-free interval (TFI) and age  independent prognostic factors  Localised tumor was found to be the only significant factor to predict COC.

15. The role of 2nd debulking in 1st relapsed Ov Ca Conclusion 1. SCR followed by C/T gives a clear survival benefit compared with C/T alone. 2. SCR should be offered when the tumor is localized. 3. The combination of COC, TFI > 24 months and age ≤ 39 years identifies a group of patients with the best OS.

16. The role of 2nd debulking in 1st relapsed Ov Ca