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Individualized chemotherapy for women with recurrent ovarian cancer: is there a survival benefit?
Morbidity of Cytoreductive Surgery in the Elderly Matthew A. Powell, MD Washington University, St. Louis, MO
Jason D. Wright, MD, Randall K. Gibb, MD, David G. Mutch, MD, Janet S. Rader, MD, and Thomas J. Herzog, MD OBJECTIVE: Although ovarian cancer is often seen in elderly patients, such women are often not treated as aggressively as younger patients. We evaluated the feasibility and morbidity of cytoreductive surgery in the elderly. METHODS: A retrospective review of all patients with invasive epithelial ovarian carcinoma who underwent exploratory laparotomy between 1996 and 2002 was performed. Clinical data were extracted from medical records. Patients were stratified by age into those younger than 70 years and those older than 70. Statistical analysis was performed using the Fisher exact and Student t tests. RESULTS: One hundred seventy-five patients were identified, 129 (74%) in the younger cohort and 46 (26%) in the older cohort. The estimated blood loss was 758 mL in the younger patients versus 667 in the older cohort (P ⫽ .35). Transfusion was required in 32% of the young versus 41% in the older patients (P ⫽ .33). Optimal cytoreduction to a largest tumor diameter of less than 1 cm was possible in 82% of the younger patients, versus 81% of the elderly (P ⬎ .999). Major and minor postoperative complications were encountered in 60% of the younger patients and 65% of the older patients (P ⫽ .70). Mean tumor size, histological classification, and stage distribution were similar in the two cohorts. At last follow-up 73% of the younger cohort and 67% of the older cohort were alive. CONCLUSIONS: Aggressive surgical cytoreduction is both safe and feasible in elderly patients. Advanced age should not be considered a contraindication to cytoreductive surgery.
Intraoperative Diagnosis and Surgical Management of Borderline Carcinoma of the Ovary Raymond M. Anchan, MD, PhD Brody School of Medicine at East Carolina University, Greenville, NC
Jim Williams, MD, Diane Semer, MD, and David L. Tait, MD OBJECTIVE: To evaluate the accuracy and effect of frozen histology on intraoperative management of borderline ovarian tumors.
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WEDNESDAY POSTERS
METHODS: Retrospective analysis of patients from 1991 to 2002 treated at a single institution for ovarian borderline carcinoma (low malignant potential [LMP] tumors) was performed. Comparison of frozen and final pathology reports assessed accuracy of frozen histology. Patient characteristics predictive of LMP tumors evaluated include tumor size, ultrasound morphology, and family history. RESULTS: Fifty-three patients with ovarian borderline carcinoma on frozen or final pathology reports were identified. Forty-three patients (81%) were determined to have LMP tumors on final pathology. Frozen-section diagnosis of LMP tumors was concordant with final histological classification in 90% of cases. Sensitivity and specificity of frozen-section diagnosis for LMP tumor were 72% and 71%, respectively, with positive and negative predictive values of 93% and 31%, respectively. Based on intraoperative frozen section evaluation, 77% of tumors identified as LMP were surgically staged, of which 84% were stage I, 4% stage II, and 12% stage III. Six percent of LMP tumors by frozen were found to be invasive cancer, and 3% with no tumor by frozen had cancer. The incidences of serous and mucinous LMP tumors were identical. Fifty-nine percent of LMP tumors by frozen had intraoperative management by gynecologic oncologists, with complete surgical staging in 87% of patients. CONCLUSIONS: Intraoperative frozen-section histology is an effective diagnostic tool for identification of ovarian borderline tumors. Our finding of a significant risk of invasive cancer associated with frozen diagnosis of LMP tumors warrants complete intraoperative surgical staging.
Individualized Chemotherapy for Women With Recurrent Ovarian Cancer: Is There a Survival Benefit? Vera Loizzi, MD University California Irvine Medical Center, Irvine, CA
John K. Chan, MD, Kathryn Osann, PhD, Fabio Capuccini, MD, Philip J. DiSaia, MD, and Michael L. Berman, MD PURPOSE: To determine the survival and response rates among patients with recurrent ovarian carcinoma (ROC) after extreme drug resistance (EDR) assay– directed therapy relative to those treated empirically. METHODS: 50 women with ROC treated with chemotherapy based on EDR assay guidance were compared with 50 wellbalanced controls who received chemotherapy based on the treating physician’s recommendation. We divided our patient population into platinum sensitive (PS) and platinum resistant (PR) groups to determine the effects of EDR-directed chemotherapy on PR and PS tumors.
OBSTETRICS & GYNECOLOGY
RESULTS: In the PS group, patients with EDR-directed therapy had an overall response rate of 65%, compared with 35% of those treated empirically (P ⫽ .02). The overall and progression-free median survivals from the start of second-line chemotherapy were 38 and 15 months in the EDR assay group and 21 and 7 months in the control group (P ⫽ .005, overall; P ⬍ .001, progression free). In the PR group, the overall response of 21% and median survival of 13 months in patients who underwent EDR-guided chemotherapy did not differ from those in patients who were treated empirically (16% and 12 months) (P ⫽ .68, response; P ⫽ .88, overall survival). In multivariate analysis, PR versus PS disease (HR ⫽ 1.77; 95% CI 1.09, 2.87), second-line chemotherapy based on clinical judgment versus EDR guidance in PS disease (HR ⫽ 1.63; 95% CI 1.02, 2.62), and advanced stage of disease (HR ⫽ 1.91; 95% CI 1.17, 3.14) were independent predictors for decreased survival.
survival remained significantly better in younger women based on Kaplan-Meier analysis stratified by performance status (0 versus 1–2, P ⫽ .02). Furthermore, overall survival was significantly better in younger women than in older women after stratification by stage (III versus IV, P ⫽ .002) and by cytoreductive surgery (optimal versus suboptimal, P ⫽ .003). Multivariable analysis demonstrated that all these factors remained as significant independent prognostic factors for survival.
CONCLUSIONS: In our series of ROC patients with PS disease, there was an improved outcome in women who had EDR-directed treatment relative to those treated without assay information.
Noninvasive Serous Papillary Carcinoma of the Endometrium: What Is the Appropriate Staging Surgery?
A Comparative Study of Younger and Older Women With Stage III and IV Invasive Ovarian Carcinoma
John K. Chan, MD
John K. Chan, MD University California Irvine Medical Center, Orange, CA
Vera Loizzi, MD, Yvonne Lin, MD, MS, Kathryn Osann, PhD, Wendy R. Brewster, MD, PhD, and Philip J. DiSaia, MD BACKGROUND: To compare the survival rates in younger (less than 45 years) and older (over 45) women diagnosed with advanced stage invasive epithelial ovarian cancer. Clinical and pathologic factors responsible for survival differences between the two groups were also determined.
CONCLUSIONS: Younger women with advanced stage invasive epithelial ovarian cancer have significantly improved survival rates relative to older patients. Age, performance status, stage of disease, and extent of cytoreductive surgery are important independent prognostic factors for survival.
University California Irvine Medical Center, Irvine, CA
Vera Loizzi, MD, Kathryn Osann, PhD, Fritz Lin, MD, Wendy R. Brewster, MD, PhD, and Philip J. DiSaia, MD OBJECTIVE: To evaluate the biologic behavior of noninvasive papillary serous carcinoma of the endometrium and its propensity for distal metastasis. METHODS: From 1990 to 2001, all women with noninvasive uterine papillary serous carcinoma (UPSC) were identified from tumor registry databases at three Southern California hospitals. Data for analysis were collected from hospital charts, office records, and tumor registry files.
METHODS: All younger women with advanced stage epithelial ovarian carcinoma diagnosed between 1984 and 2001 were identified from tumor registry databases at two hospitals. Patients with borderline tumors were excluded. An older age group of comparable controls was selected for comparison. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival.
RESULTS: Of the 100 patients diagnosed with UPSC, 16 had noninvasive lesions of the endometrium. Of the 12 patients who underwent complete surgical staging, six had confirmed stage IA disease, and the remaining six were found to have metastatic disease. Of these women with metastatic disease, two (33%) had cervical involvement, one (17%) had disease involving only the adnexa, and the remaining three (50%) had omental and adnexa involvement. One (17%) of the six women with stage IA had recurrent disease, whereas four (67%) of the six patients with metastasis at staging had recurrence. The median follow-up is 43 months.
RESULTS: Of 104 women with advanced stage epithelial ovarian carcinoma, 52 were younger than 45 and the remaining were over 45. The 5-year survival rate and median survival were 48% and 54 months in younger patients and 22% and 34 months in the older women (P ⫽ .003). Younger women had significantly better performance status than older patients, and
CONCLUSIONS: The typical pattern of spread and prognostic factors of endometrial cancer do not apply to UPSC. In our series, half of the patients with papillary serous carcinoma involving only the endometrium had metastatic disease. Thus, women with noninvasive UPSC should undergo a complete staging procedure to determine the extent of metastasis.
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
WEDNESDAY POSTERS
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Jason D. Wright, MD, Randall K. Gibb, MD, David G. Mutch, MD, Janet S. Rader, MD, and Thomas J. Herzog, MD OBJECTIVE: Although ovarian cancer is often seen in elderly patients, such women are often not treated as aggressively as younger patients. We evaluated the feasibility and morbidity of cytoreductive surgery in the elderly. METHODS: A retrospective review of all patients with invasive epithelial ovarian carcinoma who underwent exploratory laparotomy between 1996 and 2002 was performed. Clinical data were extracted from medical records. Patients were stratified by age into those younger than 70 years and those older than 70. Statistical analysis was performed using the Fisher exact and Student t tests. RESULTS: One hundred seventy-five patients were identified, 129 (74%) in the younger cohort and 46 (26%) in the older cohort. The estimated blood loss was 758 mL in the younger patients versus 667 in the older cohort (P ⫽ .35). Transfusion was required in 32% of the young versus 41% in the older patients (P ⫽ .33). Optimal cytoreduction to a largest tumor diameter of less than 1 cm was possible in 82% of the younger patients, versus 81% of the elderly (P ⬎ .999). Major and minor postoperative complications were encountered in 60% of the younger patients and 65% of the older patients (P ⫽ .70). Mean tumor size, histological classification, and stage distribution were similar in the two cohorts. At last follow-up 73% of the younger cohort and 67% of the older cohort were alive. CONCLUSIONS: Aggressive surgical cytoreduction is both safe and feasible in elderly patients. Advanced age should not be considered a contraindication to cytoreductive surgery.
Intraoperative Diagnosis and Surgical Management of Borderline Carcinoma of the Ovary Raymond M. Anchan, MD, PhD Brody School of Medicine at East Carolina University, Greenville, NC
Jim Williams, MD, Diane Semer, MD, and David L. Tait, MD OBJECTIVE: To evaluate the accuracy and effect of frozen histology on intraoperative management of borderline ovarian tumors.
106S
WEDNESDAY POSTERS
METHODS: Retrospective analysis of patients from 1991 to 2002 treated at a single institution for ovarian borderline carcinoma (low malignant potential [LMP] tumors) was performed. Comparison of frozen and final pathology reports assessed accuracy of frozen histology. Patient characteristics predictive of LMP tumors evaluated include tumor size, ultrasound morphology, and family history. RESULTS: Fifty-three patients with ovarian borderline carcinoma on frozen or final pathology reports were identified. Forty-three patients (81%) were determined to have LMP tumors on final pathology. Frozen-section diagnosis of LMP tumors was concordant with final histological classification in 90% of cases. Sensitivity and specificity of frozen-section diagnosis for LMP tumor were 72% and 71%, respectively, with positive and negative predictive values of 93% and 31%, respectively. Based on intraoperative frozen section evaluation, 77% of tumors identified as LMP were surgically staged, of which 84% were stage I, 4% stage II, and 12% stage III. Six percent of LMP tumors by frozen were found to be invasive cancer, and 3% with no tumor by frozen had cancer. The incidences of serous and mucinous LMP tumors were identical. Fifty-nine percent of LMP tumors by frozen had intraoperative management by gynecologic oncologists, with complete surgical staging in 87% of patients. CONCLUSIONS: Intraoperative frozen-section histology is an effective diagnostic tool for identification of ovarian borderline tumors. Our finding of a significant risk of invasive cancer associated with frozen diagnosis of LMP tumors warrants complete intraoperative surgical staging.
Individualized Chemotherapy for Women With Recurrent Ovarian Cancer: Is There a Survival Benefit? Vera Loizzi, MD University California Irvine Medical Center, Irvine, CA
John K. Chan, MD, Kathryn Osann, PhD, Fabio Capuccini, MD, Philip J. DiSaia, MD, and Michael L. Berman, MD PURPOSE: To determine the survival and response rates among patients with recurrent ovarian carcinoma (ROC) after extreme drug resistance (EDR) assay– directed therapy relative to those treated empirically. METHODS: 50 women with ROC treated with chemotherapy based on EDR assay guidance were compared with 50 wellbalanced controls who received chemotherapy based on the treating physician’s recommendation. We divided our patient population into platinum sensitive (PS) and platinum resistant (PR) groups to determine the effects of EDR-directed chemotherapy on PR and PS tumors.
OBSTETRICS & GYNECOLOGY
RESULTS: In the PS group, patients with EDR-directed therapy had an overall response rate of 65%, compared with 35% of those treated empirically (P ⫽ .02). The overall and progression-free median survivals from the start of second-line chemotherapy were 38 and 15 months in the EDR assay group and 21 and 7 months in the control group (P ⫽ .005, overall; P ⬍ .001, progression free). In the PR group, the overall response of 21% and median survival of 13 months in patients who underwent EDR-guided chemotherapy did not differ from those in patients who were treated empirically (16% and 12 months) (P ⫽ .68, response; P ⫽ .88, overall survival). In multivariate analysis, PR versus PS disease (HR ⫽ 1.77; 95% CI 1.09, 2.87), second-line chemotherapy based on clinical judgment versus EDR guidance in PS disease (HR ⫽ 1.63; 95% CI 1.02, 2.62), and advanced stage of disease (HR ⫽ 1.91; 95% CI 1.17, 3.14) were independent predictors for decreased survival.
survival remained significantly better in younger women based on Kaplan-Meier analysis stratified by performance status (0 versus 1–2, P ⫽ .02). Furthermore, overall survival was significantly better in younger women than in older women after stratification by stage (III versus IV, P ⫽ .002) and by cytoreductive surgery (optimal versus suboptimal, P ⫽ .003). Multivariable analysis demonstrated that all these factors remained as significant independent prognostic factors for survival.
CONCLUSIONS: In our series of ROC patients with PS disease, there was an improved outcome in women who had EDR-directed treatment relative to those treated without assay information.
Noninvasive Serous Papillary Carcinoma of the Endometrium: What Is the Appropriate Staging Surgery?
A Comparative Study of Younger and Older Women With Stage III and IV Invasive Ovarian Carcinoma
John K. Chan, MD
John K. Chan, MD University California Irvine Medical Center, Orange, CA
Vera Loizzi, MD, Yvonne Lin, MD, MS, Kathryn Osann, PhD, Wendy R. Brewster, MD, PhD, and Philip J. DiSaia, MD BACKGROUND: To compare the survival rates in younger (less than 45 years) and older (over 45) women diagnosed with advanced stage invasive epithelial ovarian cancer. Clinical and pathologic factors responsible for survival differences between the two groups were also determined.
CONCLUSIONS: Younger women with advanced stage invasive epithelial ovarian cancer have significantly improved survival rates relative to older patients. Age, performance status, stage of disease, and extent of cytoreductive surgery are important independent prognostic factors for survival.
University California Irvine Medical Center, Irvine, CA
Vera Loizzi, MD, Kathryn Osann, PhD, Fritz Lin, MD, Wendy R. Brewster, MD, PhD, and Philip J. DiSaia, MD OBJECTIVE: To evaluate the biologic behavior of noninvasive papillary serous carcinoma of the endometrium and its propensity for distal metastasis. METHODS: From 1990 to 2001, all women with noninvasive uterine papillary serous carcinoma (UPSC) were identified from tumor registry databases at three Southern California hospitals. Data for analysis were collected from hospital charts, office records, and tumor registry files.
METHODS: All younger women with advanced stage epithelial ovarian carcinoma diagnosed between 1984 and 2001 were identified from tumor registry databases at two hospitals. Patients with borderline tumors were excluded. An older age group of comparable controls was selected for comparison. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival.
RESULTS: Of the 100 patients diagnosed with UPSC, 16 had noninvasive lesions of the endometrium. Of the 12 patients who underwent complete surgical staging, six had confirmed stage IA disease, and the remaining six were found to have metastatic disease. Of these women with metastatic disease, two (33%) had cervical involvement, one (17%) had disease involving only the adnexa, and the remaining three (50%) had omental and adnexa involvement. One (17%) of the six women with stage IA had recurrent disease, whereas four (67%) of the six patients with metastasis at staging had recurrence. The median follow-up is 43 months.
RESULTS: Of 104 women with advanced stage epithelial ovarian carcinoma, 52 were younger than 45 and the remaining were over 45. The 5-year survival rate and median survival were 48% and 54 months in younger patients and 22% and 34 months in the older women (P ⫽ .003). Younger women had significantly better performance status than older patients, and
CONCLUSIONS: The typical pattern of spread and prognostic factors of endometrial cancer do not apply to UPSC. In our series, half of the patients with papillary serous carcinoma involving only the endometrium had metastatic disease. Thus, women with noninvasive UPSC should undergo a complete staging procedure to determine the extent of metastasis.
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
WEDNESDAY POSTERS
107S