Followup operations not helping
Second surgery can cause harm, study suggests
Going back into the operating room for surgery to help a woman whose ovarian cancer has reappeared may not help her live longer — instead, it might shorten her life, according to an international study of 485 women.
“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 tumour reappears do as well or better than women who received surgery before their chemotherapy. The results only apply to women whose tumours are sensitive to platinum-based drugs.
After a median followup 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 per cent 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 per cent of women have their disease recur, the 10-year survival rate is below 15 per cent, and roughly 14,000 are expected to die from their tumours. Roughly half of affected women have platinum-sensitive tumours.
The trial, known as GOG0213, ended early when preliminary results showed that surgery was not helping. The volunteers had recurrent epithelial ovarian, primary peritoneal, or Fallopian-tube cancer.
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 per cent of the patients in the surgery group survived for three years versus 74 per cent 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.
Coleman said M.D. Anderson and other cancer centres have stopped doing routine secondary surgery in the wake of the findings, but it may take time for other medical centres to follow suit.