Giudice Maria Teresa, D'Indinosante Marco, Cappuccio Serena, Gallotta Valerio, Fagotti Anna, Scambia Giovanni, Petrillo Marco
Department of Woman and Child Health, IRCCS Fondazione Policlinico Agostino Gemelli, 00168, Rome, Italy.
Gynecologic and Obstetric Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
Arch Gynecol Obstet. 2018 Nov;298(5):873-879. doi: 10.1007/s00404-018-4915-1. Epub 2018 Sep 25.
To identify women affected by recurrent ovarian cancer who benefit from secondary cytoreductive surgery (SCS), analyse their clinical and biological features and investigate the role of minimally invasive surgery (MIS) and hyperthermic intraperitoneal-based chemotherapy (HIPEC) in this subset of patients.
This narrative review examines the data available from the updated literature. An electronic literature search was conducted in PubMed Medline databases for articles published from 1990 to 2018.
Retrospective studies and preliminary data from the AGO-Desktop III trial show that cytoreductive surgery is associated with improved post-relapse survival in patients with platinum-sensitive relapse, compared to chemotherapy alone. This benefit is more evident in patients treated with complete or optimal primary debulking surgery at referral centres, who did not receive bevacizumab in first-line chemotherapy, and who present a localized pattern of disease. MIS has been proven to be a favourable approach to achieve a complete secondary debulking, reducing peri- and postoperative comorbidities. The application of HIPEC to SCS is associated with an improvement in oncological outcomes by preliminary results.
While waiting for the final results of the ongoing randomized controlled trials, SCS seems feasible and safe in selected patients with recurrent ovarian cancer. Recently, more attention has been focused on the biological features of ovarian tumours, such as BRCA status. Further studies and molecular research should be conducted to identify individualized and targeted therapies in the treatment of ovarian cancer recurrences.
识别能从二次肿瘤细胞减灭术（SCS）中获益的复发性卵巢癌女性患者，分析其临床和生物学特征，并探讨微创手术（MIS）和基于腹腔内热灌注化疗（HIPEC）在这部分患者中的作用。
本叙述性综述研究了最新文献中的可用数据。在PubMed Medline数据库中进行了电子文献检索，以查找1990年至2018年发表的文章。
回顾性研究以及AGO-Desktop III试验的初步数据表明，与单纯化疗相比，肿瘤细胞减灭术与铂敏感复发患者复发后的生存率提高相关。这种益处在转诊中心接受了完全或最佳初次肿瘤细胞减灭术、一线化疗未接受贝伐单抗且疾病呈局限性的患者中更为明显。已证明MIS是实现完全二次肿瘤细胞减灭的有利方法，可减少围手术期和术后合并症。初步结果显示，HIPEC应用于SCS与肿瘤学结局改善相关。
在等待正在进行的随机对照试验的最终结果期间，SCS在部分复发性卵巢癌患者中似乎可行且安全。最近，更多关注集中在卵巢肿瘤的生物学特征，如BRCA状态。应开展进一步研究和分子研究，以确定复发性卵巢癌治疗中的个体化和靶向治疗方法。
