In a European Network of Gynecologic Oncology Trialists–Gynecologic Cancer Intergroup trial (DESKTOP III) reported in The New England Journal of Medicine, Philipp Harter, MD, PhD, and colleagues found that the addition of cytoreductive surgery to platinum-based chemotherapy improved overall survival in women with relapsed ovarian cancer.

In women with recurrent ovarian cancer, cytoreductive surgery followed by chemotherapy resulted in longer overall survival than chemotherapy alone.

— Philipp Harter, MD, PhD, and colleagues

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Study Details

In the multinational trial, 407 patients with first relapse after a platinum-free interval of ≥ 6 months were randomly assigned between September 2010 and March 2015 to receive secondary cytoreductive surgery followed by physician’s choice of platinum-based chemotherapy (n = 206) or platinum-based chemotherapy alone (n = 201). Patients had to have a positive Arbeitsgemeinschaft Gynakologische Onkologie (AGO) score (Eastern Cooperative Oncology Group performance status score of 0), ascites of < 500 mL, and complete resection at initial surgery. The primary endpoint was overall survival in the intent-to-treat population.

Overall Survival

Macroscopic complete resection was achieved in 145 (75.5%) of 192 patients in the surgery group who underwent the procedure (70.4% of all patients). At least five cycles of chemotherapy were received by 76.7% of patients in the surgery group and 79.6% of those in the no-surgery group.

Median follow-up was 69.8 months (interquartile range = 59.8–80.4 months). Median overall survival was 53.7 months (95% confidence interval [CI] = 46.8–61.6 months) in the surgery group vs 46.0 months (95% CI = 39.5–52.6 months) in the no-surgery group (hazard ratio [HR] = 0.75, 95% CI = 0.59–0.96, P = .02). Hazard ratios were 0.59 (95% CI = 0.37–0.94) among 95 patients with a platinum-free interval of 6 to 12 months and 0.83 (95% CI = 0.62–1.11) among 306 with a platinum-free interval of longer than 12 months.

Among patients in the surgery group who underwent surgery, median overall survival was 55.5 months (95% CI = 48.2–62.0 months). Among patients in the surgery group who underwent complete resection, median overall survival was 61.9 months (95% CI = 55.3–78.9 months), compared with 27.7 months (95% CI = 23.5–38.7 months) among patients who did not undergo surgery or did not achieve complete resection.

Median progression-free survival was 18.4 months (95% CI = 15.7–20.8 months) in the surgery group vs 14.0 months (95% CI = 12.7–15.4 months) in the no-surgery group (HR = 0.66, 95% CI = 0.54–0.82). Among patients in the surgery group who underwent surgery, the median progression-free survival was 18.5 months (95% CI = 15.9–21.0 months).

No deaths were reported within 30 days after surgery. Reoperation was performed in 3.7% of patients who underwent surgery. Quality-of-life analysis showed no between-group differences in global health status, quality of life, or any function subscales at baseline, 6 months, or 12 months.

The investigators concluded, “In women with recurrent ovarian cancer, cytoreductive surgery followed by chemotherapy resulted in longer overall survival than chemotherapy alone.”

Disclosure: The study was funded by the AGO Study Group, GlaxoSmithKline, and Medac. For full disclosures of the study authors, visit nejm.org.