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ABSTRACT: PURPOSE: To analyze quality of life (QOL) in a randomized, placebo-controlled phase III trial concluding that the addition of concurrent and maintenance bevacizumab (Arm 3) to carboplatin and paclitaxel prolongs progression-free survival in front-line treatment of advanced ovarian cancer compared to chemotherapy alone (Arm 1) or chemotherapy with bevacizumab in cycles 2-6 only (Arm 2). PATIENTS AND METHODS: The Trial Outcome Index of the Functional Assessment of Cancer Therapy-Ovary (FACT-O TOI) was used to assess QOL before cycles 1, 4, 7, 13, and 21; and 6 months after completing study therapy. Differences in QOL scores were assessed using a linear mixed model, adjusting for baseline score, and age. The significance level was set at 0.0167 to account for multiple comparisons. RESULTS: 1693 patients were queried. Arm 2 (p<0.001) and Arm 3 (p<0.001) reported lower QOL scores than those in Arm 1. The treatment differences were observed mainly at cycle 4, when the patients receiving bevacizumab (Arm 2 and Arm 3) reported 2.72 points (98.3% CI: 0.88 ~ 4.57; effect size=0.18) and 2.96 points (98.3% CI: 1.13~4.78; effect size=0.20) lower QOL respectively, than those in Arm 1. The difference in QOL scores between Arm 1 and Arm 3 remained statistically significant up to cycle 7. The percentage of patients who reported abdominal discomfort dropped over time, without significant differences among study arms. CONCLUSION: The small QOL difference observed during chemotherapy did not persist during maintenance bevacizumab.
Gynecologic Oncology 12/2012; · 3.89 Impact Factor
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Robert A Burger,
Mark F Brady,
Michael A Bookman,
Gini F Fleming,
Bradley J Monk,
Helen Huang,
Robert S Mannel,
Howard D Homesley,
Jeffrey Fowler, Benjamin E Greer,
Matthew Boente,
Michael J Birrer,
Sharon X Liang
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ABSTRACT: Vascular endothelial growth factor is a key promoter of angiogenesis and disease progression in epithelial ovarian cancer. Bevacizumab, a humanized anti-vascular endothelial growth factor monoclonal antibody, has shown single-agent activity in women with recurrent tumors. Thus, we aimed to evaluate the addition of bevacizumab to standard front-line therapy.
In our double-blind, placebo-controlled, phase 3 trial, we randomly assigned eligible patients with newly diagnosed stage III (incompletely resectable) or stage IV epithelial ovarian cancer who had undergone debulking surgery to receive one of three treatments. All three included chemotherapy consisting of intravenous paclitaxel at a dose of 175 mg per square meter of body-surface area, plus carboplatin at an area under the curve of 6, for cycles 1 through 6, plus a study treatment for cycles 2 through 22, each cycle of 3 weeks' duration. The control treatment was chemotherapy with placebo added in cycles 2 through 22; bevacizumab-initiation treatment was chemotherapy with bevacizumab (15 mg per kilogram of body weight) added in cycles 2 through 6 and placebo added in cycles 7 through 22. Bevacizumab-throughout treatment was chemotherapy with bevacizumab added in cycles 2 through 22. The primary end point was progression-free survival.
Overall, 1873 women were enrolled. The median progression-free survival was 10.3 months in the control group, 11.2 in the bevacizumab-initiation group, and 14.1 in the bevacizumab-throughout group. Relative to control treatment, the hazard ratio for progression or death was 0.908 (95% confidence interval [CI], 0.795 to 1.040; P=0.16) with bevacizumab initiation and 0.717 (95% CI, 0.625 to 0.824; P<0.001) with bevacizumab throughout. At the time of analysis, 76.3% of patients were alive, with no significant differences in overall survival among the three groups. The rate of hypertension requiring medical therapy was higher in the bevacizumab-initiation group (16.5%) and the bevacizumab-throughout group (22.9%) than in the control group (7.2%). Gastrointestinal-wall disruption requiring medical intervention occurred in 1.2%, 2.8%, and 2.6% of patients in the control group, the bevacizumab-initiation group, and the bevacizumab-throughout group, respectively.
The use of bevacizumab during and up to 10 months after carboplatin and paclitaxel chemotherapy prolongs the median progression-free survival by about 4 months in patients with advanced epithelial ovarian cancer. (Funded by the National Cancer Institute and Genentech; ClinicalTrials.gov number, NCT00262847.).
New England Journal of Medicine 12/2011; 365(26):2473-83. · 53.30 Impact Factor
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ABSTRACT: A phase 2 trial was conducted to determine the toxicity and efficacy of combined weekly topotecan and biweekly bevacizumab in patients with primary or secondary platinum-resistant ovarian, peritoneal, or fallopian tube cancer (OC).
Patients were treated with bevacizumab 10 mg/kg on days 1 and 15 and topotecan 4 mg/m(2) on days 1, 8, and 15 of a 28-day cycle until progressive disease (PD) or excessive toxicity. The primary endpoint was progression-free survival (PFS); secondary objectives included overall survival (OS), objective response, and toxicity.
Patients (N = 40) received a median of 8 treatment cycles. Toxicity was generally mild or moderate, with neutropenia (18%), hypertension (20%), gastrointestinal toxicity (18%), pain (13%), metabolic toxicity (15%), bowel obstruction (10%), and cardiotoxicity (8%) being the most common grade 3 and 4 adverse events. No bowel perforations, febrile neutropenia, or treatment-related deaths occurred. Median PFS and OS were 7.8 (95% confidence interval [CI], 3.0-9.4) and 16.6 months (95% CI, 12.8-22.9), with 22 (55%) patients progression-free for ≥6 months. Ten (25%) patients had partial response (PR), 14 (35%) had stable disease (SD), and 16 (40%) had PD. Patients treated with 2 prior regimens received greater benefit than patients treated with 1: PR/SD, 78.9% versus 42.9% (P = .03); median PFS, 10.9 versus 2.8 months (P = .08); median OS, 22.9 versus 12.8 months (P = .02).
A weekly topotecan and biweekly bevacizumab combination demonstrates acceptable toxicity and encouraging efficacy in patients with platinum-resistant OC; further study is warranted.
Cancer 08/2011; 117(16):3731-40. · 4.77 Impact Factor
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Ernest S Han,
Robert A Burger,
Kathleen M Darcy,
Michael W Sill,
Leslie M Randall,
Dana Chase,
Basmina Parmakhtiar,
Bradley J Monk, Benjamin E Greer,
Patrick Connelly,
Koen Degeest,
John P Fruehauf
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ABSTRACT: Potential predictive/prognostic angiogenic markers were prospectively examined in a phase II trial of bevacizumab in epithelial ovarian cancer (EOC)/primary peritoneal cancer (PPC).
Recurrent/persistent EOC/PPC patients were treated with bevacizumab (15 mg/kg IV q21days) until disease progression. Validated-immunohistochemistry (IHC) assays were performed on pre-cycle 1/4 tumor biopsies for CD31-microvessel density (MVD), VEGF-histoscore (HS), p53-HS, and TSP1 image analysis score (IA). Pre-cycle 1/4 serum and plasma VEGF were quantified using a validated-ELISA.
CD31-MVD and serum VEGF, evaluated pre-cycle 1 in 41/61 and 51/61 eligible patients, respectively, did not appear to be correlated. High CD31-MVD, categorized at the median, appeared to be associated with tumor response, a 13-month shorter median survival, and an increased risk of death (unadjusted hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.067-4.467). In addition, each standard deviation (SD) increase in CD31-MVD appeared to be associated with worse survival in unadjusted and adjusted analyses. IHC and plasma biomarkers did not change with bevacizumab treatment except for serum VEGF, which appeared to decrease during bevacizumab treatment. This decrease was not associated with response. High pre-cycle 1 serum VEGF, categorized at the median, was associated with 22-month shorter median survival and an increased risk of death (unadjusted HR = 2.7, 95% CI = 1.369-5.191). Categorized p53 appeared to be associated with unadjusted survival and each SD increase in TSP1-IA appeared to be associated with a decreased risk of progression in unadjusted and adjusted analyses.
Despite the limitations in sample size and exploratory nature of the study, angiogenic markers in tumor and serum may provide prognostic value in recurrent/persistent EOC/PPC, and are being prospectively evaluated in the GOG phase III trial of carboplatin, paclitaxel and bevacizumab/placebo in previously untreated EOC/PPC.
Gynecologic Oncology 12/2010; 119(3):484-90. · 3.89 Impact Factor
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Benjamin E Greer,
Wui-Jin Koh,
Nadeem R Abu-Rustum,
Sachin M Apte,
Susana M Campos,
John Chan,
Kathleen R Cho,
Larry Copeland,
Marta Ann Crispens,
Nefertiti Dupont, [......],
John R Lurain,
Lainie Martin,
Mark A Morgan,
Robert J Morgan,
David Mutch,
Steven W Remmenga,
R Kevin Reynolds,
William Small,
Nelson Teng,
Fidel A Valea
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ABSTRACT: Overview An estimated 12,200 new cases of cervical cancer will be diagnosed in the United States in 2010, and 4200 people will die of the disease.(1) Cervical cancer rates are decreasing among women in the United States, although incidence remains high among Hispanic/Latino, black, and Asian women.(2-5) However, cervical cancer is a major world health problem for women. The global yearly incidence of cervical cancer for 2002 was 493,200; the annual death rate was 273,500. It is the third most common cancer in women worldwide,(6,7) with 78% of cases occurring in developing countries, where cervical cancer is the second most frequent cause of cancer death in women. Persistent human papillomavirus (HPV) infection is regarded as the most important factor contributing to the development of cervical cancer. A relationship seems to exist between the incidence of cervical cancer and the prevalence of HPV in the population. The prevalence of chronic HPV in countries with a high incidence of cervical cancer is 10% to 20%, whereas its prevalence in low-incidence countries is 5% to 10%.(6) Immunization against HPV prevents infection with certain types of HPV and, thus, is expected to prevent specific HPV cancer in women (see NCCN Clinical Practice Guidelines in Oncology [NCCN Guidelines] for Cervical Cancer Screening, in this issue; to view the most recent version of these guidelines, visit the NCCN Web site at www.NCCN.org).(8-12) Other epidemiologic risk factors associated with cervical cancer are a history of smoking, parity, contraceptive use, early age at onset of coitus, larger number...
Journal of the National Comprehensive Cancer Network: JNCCN 12/2010; 8(12):1388-416. · 4.41 Impact Factor
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Benjamin E Greer,
Wui-Jin Koh,
Nadeem Abu-Rustum,
Michael A Bookman,
Robert E Bristow,
Susana M Campos,
Kathleen R Cho,
Larry Copeland,
Marta Ann Crispens,
Patricia J Eifel, [......],
John J Kavanagh,
John R Lurain,
Mark Morgan,
Robert J Morgan,
C Bethan Powell,
Steven W Remmenga,
R Kevin Reynolds,
Angeles Alvarez Secord,
William Small,
Nelson Teng
Journal of the National Comprehensive Cancer Network: JNCCN 06/2009; 7(5):498-531. · 4.41 Impact Factor
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John Farley,
Sartoru Fuchiuji,
Kathleen M Darcy,
Chunqiao Tian,
William J Hoskins,
William P McGuire,
Parviz Hanjani,
David Warshal, Benjamin E Greer,
Jerome Belinson,
Michael J Birrer
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ABSTRACT: The Gynecologic Oncology Group (GOG) examined the association between ERBB2 amplification and clinical covariates, tumor response, disease status post-chemotherapy, progression-free survival (PFS), and overall survival (OS) in epithelial ovarian cancer (EOC).
Women with suboptimally-resected, advanced stage EOC who participated in GOG-111, a multi-center randomized phase III trial of cyclophosphamide+cisplatin versus paclitaxel+cisplatin, and provided a tumor block through the companion protocol GOG-9404 were eligible. ERBB2 amplification was examined using fluorescence in situ hybridization (FISH) with probes for ERBB2 and the centromere of chromosome 17 (CEP17).
ERBB2 amplification, defined as >2 copies of ERBB2/CEP17, was a rare event in EOC with 7% (9/133) of women exhibiting between 2.2 and 33.7 copies of ERBB2/CEP17, and was not associated with patient age, race, GOG performance status, stage, cell type, grade, measurable disease status, volume of ascites, tumor response or disease status post-chemotherapy. Women with >2 verses < or =2 copies of ERBB2/CEP17 did not have a reduced risk of disease progression (hazard ratio [HR]=0.56; 95% confidence interval [CI]=0.27-1.16; p=0.120) or death (HR=0.57; 95% CI=0.26-1.23; p=0.152), and ERBB2 amplification was not an independent prognostic factor for PFS or OS. ERBB2 amplification, defined as >4 copies of ERBB2/nuclei, was observed in 9% (12/133) of women with levels ranging from 4.2 to 49.2 copies of ERBB2/nuclei, and was associated with older age and volume of ascites, but not with the other clinical covariates or outcome.
ERBB2 amplification is a rare event and has no predictive or prognostic value in suboptimally-resected, advanced stage EOC treated with platinum-based combination chemotherapy.
Gynecologic Oncology 03/2009; 113(3):341-7. · 3.89 Impact Factor
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Robert J Morgan,
Ronald D Alvarez,
Deborah K Armstrong,
Barry Boston,
Lee-may Chen,
Larry Copeland,
Jeff Fowler,
David K Gaffney,
David Gershenson, Benjamin E Greer, [......],
Carolyn Johnston,
Johnathan M Lancaster,
Shashikant Lele,
Ursula Matulonis,
David O'Malley,
Robert F Ozols,
Steven W Remmenga,
Paul Sabbatini,
Julian Schink,
Nelson Teng
Journal of the National Comprehensive Cancer Network: JNCCN 10/2008; 6(8):766-94. · 4.41 Impact Factor
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Edward E Partridge,
Nadeem Abu-Rustum,
Susan Campos,
Patrick J Fahey, Benjamin E Greer,
Subodh M Lele,
Richard W Lieberman,
Gary H Lipscomb,
Mark Morgan,
Maria Enriqueta R Nava,
R Kevin Reynolds,
Diljeet K Singh,
Karen Smith-McCune,
Nelson Teng,
Cornelia Liu Trimble,
Fidel Valea,
Sharon Wilczynski
Journal of the National Comprehensive Cancer Network: JNCCN 02/2008; 6(1):58-82. · 4.41 Impact Factor
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Benjamin E Greer,
Wui-Jin Koh,
Nadeem Abu-Rustum,
Michael A Bookman,
Robert E Bristow,
Susana Campos,
Kathleen R Cho,
Larry Copeland,
Patricia Eifel,
Warner K Huh, [......],
Gary H Lipscomb,
John R Lurain,
Mark Morgan,
Robert J Morgan,
C Bethan Powell,
Steven W Remmenga,
R Kevin Reynolds,
Angeles Alvarez Secord,
William Small,
Nelson Teng
Journal of the National Comprehensive Cancer Network: JNCCN 02/2008; 6(1):14-36. · 4.41 Impact Factor
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ABSTRACT: Vascular endothelial growth factor (VEGF) seems to be a promoter of tumor progression for epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC). We conducted a phase II trial to assess the efficacy and tolerability of single-agent bevacizumab, an anti-VEGF monoclonal antibody.
Eligible patients had persistent or recurrent EOC/PPC after one to two prior cytotoxic regimens, measurable disease, and Gynecologic Oncology Group performance status of at least 2. Treatment consisted of bevacizumab 15 mg/kg intravenously every 21 days until disease progression or prohibitive toxicity. Primary end points were progression-free survival (PFS) at 6 months and clinical response.
The study consisted of 62 eligible and assessable patients, median age 57 years, 41 (66.1%) having received two prior regimens and 26 (41.9%) considered platinum resistant. Grade 3 adverse events at least possibly related to bevacizumab were hematologic (1), GI (3), hypertension (6), thromboembolism (1), allergy (2), hepatic (1), pain (3), coagulation (1), constitutional (1), and dyspnea (1). Grade 4 adverse events included pulmonary embolus (1), vomiting and constipation (1), and proteinuria (1). Thirteen patients (21.0%) experienced clinical responses (two complete, 11 partial; median response duration, 10 months), and 25 (40.3%) survived progression free for at least 6 months. Median PFS and overall survival were 4.7 and 17 months, respectively. There was no significant association of prior platinum sensitivity, age, number of prior chemotherapeutic regimens, or performance status with the hazard of progression or death.
Bevacizumab seems to be well tolerated and active in the second- and third-line treatment of patients with EOC/PPC and merits phase III investigation.
Journal of Clinical Oncology 12/2007; 25(33):5165-71. · 18.37 Impact Factor
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ABSTRACT: Based on the activity and tolerability of liposomal doxorubicin in platinum- and paclitaxel-resistant ovarian carcinoma, we conducted a phase I trial of pegylated liposomal doxorubicin with paclitaxel and carboplatin to determine the maximum tolerated dose (MTD) in chemotherapy naive ovarian, peritoneal and tubal carcinoma patients.
Three schedules were studied: paclitaxel, carboplatin and pegylated liposomal doxorubicin every 28 days; paclitaxel and carboplatin every 21 days with liposomal doxorubicin every 42 days; and weekly paclitaxel, carboplatin (AUC=5) every 21 days and liposomal doxorubicin every 42 days. The paclitaxel dose was 175 mg/m(2) over 3 h on an every 3-4 week schedule and 60 mg/m(2) when administered weekly. Based on the frequency of neutropenic sepsis, grade 4 thrombocytopenia and > or =grade 3 non-hematologic toxicity, the starting dose of liposomal doxorubicin of 20 mg/m(2) was escalated to determine the MTD.
A total of 210 (21-day) cycles were administered to 37 patients. Dose-limiting toxicity (DLT) occurred when liposomal doxorubicin was administered at 40 mg/m(2). Because of treatment-related delays resulting in decreased paclitaxel/carboplatin dose intensity, administration was modified to be given every 21 days, with liposomal doxorubicin given every 42 days. Since neutropenia was the DLT of this schedule, the schema was further modified to administer paclitaxel weekly; however, weekly administration was inconsistent because of toxicity.
Paclitaxel 175 mg/m(2), carboplatin (AUC=5) and pegylated liposomal doxorubicin 30 mg/m(2) are tolerable without supportive therapy. The usual dose intensity of paclitaxel/carboplatin was maintained by administering liposomal doxorubicin every other cycle.
Gynecologic Oncology 02/2007; 104(1):114-9. · 3.89 Impact Factor
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Robert J Morgan,
Ronald D Alvarez,
Deborah K Armstrong,
Lee-May Chen,
Larry Copeland,
Jeff Fowler,
David K Gaffney,
David Gershenson, Benjamin E Greer,
Carolyn Johnston,
Johnathan M Lancaster,
Shashikant Lele,
Ursula Matulonis,
Robert F Ozols,
Steven W Remmenga,
Paul Sabbatini,
John Soper,
Nelson Teng
Journal of the National Comprehensive Cancer Network: JNCCN 11/2006; 4(9):912-39. · 4.41 Impact Factor
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Benjamin E Greer,
Wui-Jin Koh,
Nadeem Abu-Rustum,
Michael A Bookman,
Robert E Bristow,
Susana Campos,
Kathleen R Cho,
Larry Copeland,
Patricia Eifel,
Wainwright Jaggernauth, [......],
John R Lurain,
Robert J Morgan,
Subir Nag,
Edward E Partridge,
C Bethan Powell,
Steven W Remmenga,
R Kevin Reynolds,
William Small,
John Soper,
Nelson Teng
Journal of the National Comprehensive Cancer Network: JNCCN 06/2006; 4(5):438-62. · 4.41 Impact Factor
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ABSTRACT: Molecular imaging through positron emission tomography (PET) is playing a very important role in the management of several different cancers. Its noninvasive nature and ability to study biologic function are ideal for oncology practice. PET is establishing itself in staging, guiding therapy, and follow-up of patients with cervical cancer. The emergence and widespread availability of combined PET/computed tomography technology has further consolidated the role of molecular scanning in managing these patients. This technology is now accessible to every cancer center in the United States and is also available in most countries. Although it is approved for staging patients with cervical cancer, its use in other clinical management situations is being evaluated. The real power of molecular imaging will be to predict treatment response and guide therapy and applications of novel PET tracers for studying complex cellular functions that characterize the tumor for individualized treatment approaches. Although PET technology is beyond the reach of many developing countries, the experience gained in major centers would help devise more effective and simpler treatments that can be introduced.
Journal of the National Comprehensive Cancer Network: JNCCN 06/2006; 4(5):463-9. · 4.41 Impact Factor
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Benjamin E Greer,
Brian N Bundy,
Robert F Ozols,
Jeffrey M Fowler,
Daniel Clarke-Pearson,
Robert A Burger,
Robert Mannel,
Koen DeGeest,
Ellen M Hartenbach,
Rebecca N Baergen,
Larry J Copeland
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ABSTRACT: A non-randomized comparison of outcome in women undergoing second-look laparotomy (SLL) or clinical follow-up, after receiving six cycles of combination chemotherapy with paclitaxel plus either cisplatin or carboplatin, for optimally resected stage III ovarian cancer.
Prior to chemotherapy randomization, patients chose whether or not to undergo SLL; this was a stratification factor to insure balance of treatment assignment. Any subsequent therapy was physician-directed. Explanatory analysis replaced intent-to-treat because of a higher likelihood of detecting SLL effect in the presence of noncompliance.
There were 393 patients (median age: 54) who Elected SLL and 399 (median age: 59) who Elected No SLL. The former group was more likely to have gross residual disease at initial surgery than the latter group (69% versus 60%, respectively). In the Elected SLL group, 59 (15%) patients subsequently refused surgery, in nine (2%) surgery was contraindicated, and 31 (8%) relapsed or died prior to the procedure. Cancer was found in 46% of 294 (75%) patients undergoing SLL. Since early failures (prior to SLL) do not address benefit, such patients (SLL: 32; No SLL: 33), defined as progression-free survival (PFS) < 6 months, were excluded from analysis. The adjusted relative risk of progression is 0.89 (95% confidence interval: 0.75, 1.07); the difference in median PFS is 1.0 month (SLL: 23.9 months; No SLL: 22.9 months). The survival rate curves are superimposable.
In the context of a non-randomized comparison, the performance of a SLL was not associated with longer survival.
Gynecologic Oncology 10/2005; 99(1):71-9. · 3.89 Impact Factor
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Edward E Partridge,
Nadeem R Abu-Rustum,
Susana Campos,
Mitchell Edelson,
Patrick J Fahey,
James Fiorica, Benjamin E Greer,
Richard W Lieberman,
Wendy Likes,
Kelly L Molpus,
Maria Enriqueta R Nava,
R Kevin Reynolds,
Diljeet K Singh,
Karen Smith-McCune,
John Soper,
Nelson Teng,
Cornelia Liu Trimble,
Sharon Wilczynski
Journal of the National Comprehensive Cancer Network: JNCCN 11/2004; 2(6):570-87. · 4.41 Impact Factor
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Nelson Teng,
Nadeem R Abu-Rustum,
Afshin Bahador,
Michael A Bookman,
Robert E Bristow,
Susana Campos,
Kathleen R Cho,
Larry Copeland,
Patricia Eifel,
James Fiorica, [......],
Michael Kuettel,
John R Lurain,
Kelly L Molpus,
Subir Nag,
Edward E Partridge,
C Bethan Powell,
R Kevin Reynolds,
William Small,
John Soper,
Todd D Tillmanns
Journal of the National Comprehensive Cancer Network: JNCCN 11/2004; 2(6):612-30. · 4.41 Impact Factor
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Robert J Morgan,
Ronald D Alvarez,
Deborah K Armstrong,
Lee-may Chen,
Larry Copeland,
James Fiorica,
Jeff Fowler,
David K Gaffney,
David Gershenson, Benjamin E Greer,
Edward C Grendys,
Carolyn Johnston,
Shashikant Lele,
Ursula A Matulonis,
Kelly L Molpus,
Robert F Ozols,
Paul Sabbatini,
Joseph T Santoso,
John Soper,
Nelson Teng
Journal of the National Comprehensive Cancer Network: JNCCN 11/2004; 2(6):526-47. · 4.41 Impact Factor
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ABSTRACT: Ovarian cancer is the second most common gynecologic cancer in women and the leading cause of death caused by gynecologic malignancy. Surgery plays a fundamental role in treating this challenging disease. Goals of primary surgery for ovarian cancer are to establish diagnosis, proper staging, determination of prognosis, and optimal cytoreduction of gross disease before chemotherapy for improved outcome. In addition to standard removal of the ovaries, uterus, omentum, and pelvic and para-aortic lymph nodes for early disease, extended surgical techniques used to debulk advanced disease include bowel resection, splenectomy, partial liver resection, peritoneal or diaphragmatic stripping, and use of laser or ultrasound (CUSA). Secondary surgery is used in a variety of situations. Second-look procedures were performed historically to determine response to chemotherapy to delineate duration of treatment, but now are best used in a research setting with the advent of improved chemotherapeutic agents. As a high percentage of patients have a gynecologic malignancy recurrence after primary treatment, many practitioners perform secondary cytoreductive procedures for recurrent disease. Additionally, in the recurrent setting, surgery may be necessary for relief of bowel obstruction and palliation of symptoms. Surgical management of ovarian cancer must be performed by surgeons, such as gynecologic oncologists, who have a firm understanding of the disease process, display good clinical judgment, and are adequately trained to perform the complex surgery that commonly is required for appropriate care.
Journal of the National Comprehensive Cancer Network: JNCCN 11/2004; 2(6):561-8. · 4.41 Impact Factor
