Role of cytoreductive surgery in recurrent ovarian cancer

Ovarian cancer is the leading cause of death from gynecologic malignancy in western countries, primarily because over 60% of patients with ovarian cancer will experience disease recurrence. Primary cytoreductive surgery and combination chemotherapy are the cornerstones of the initial treatment for epithelial ovarian cancer. The management of recurrent ovarian cancer is less clear than that of primary disease. The management of recurrent ovarian cancer is largely based on systemic chemotherapy, with surgery being offered only in selected individuals. Despite this, the benefits of surgery has been shown in a meta-analysis by Bristow et al. where the survival is influenced by the completeness of cytoreduction. Therefore, epithelial ovarian cancer can be accepted as a chronic disease that consists of multiple recurrence and retreatments such as further surgeries and chemotherapies. The clinical applicability of this secondary surgery remains a controversial topic. Therefore, a trial on secondary surgery for recurrent ovarian cancer and the role of hyperthermic intraoperative peritoneal chemotherapy in addition to the current standard of care of administering systemic chemotherapy alone is warranted. The current data supported that the selection criteria to offer secondary cytoreduction represents one of the most important challenges. There are, to date, no Phase III trials that demonstrate the clinical utility of either secondary surgical cytoreduction or hyperthermic intraperitoneal chemotherapy in epithelial ovarian cancer. © 2010 Future Medicine Ltd.