LAUSR

(2019) For decades, patients with recurrent ovarian cancer have undergone secondary cytoreductive surgery (SCS). “The prevailing opinion, based on retrospective series and included in the National Comprehensive Cancer Network guidelines, was that surgery should be considered in selected patients,” summarizes lead investigator Robert Coleman. The results of the prospective randomized controlled GOG-0213 trial now indicate that SCS followed by chemotherapy does not improve overall survival (OS) over chemotherapy alone. “We designed GOG-0213 to answer two questions: does the addition of bevacizumab improve the effect of paclitaxel and carboplatin chemotherapy, and does secondary surgery improve survival outcomes,” explains Coleman. Women with platinumsensitive recurrent epithelial ovarian cancer were randomly assigned to SCS followed by platinumbased chemotherapy (n = 240) or chemotherapy alone (n = 245). At a median followup duration of 48.1 months, “the median OS with surgery borders on being almost harmful,” Coleman opines. Indeed, median OS durations were 50.6 months and 64.7 months with SCS and chemotherapy alone, respectively (HR 1.29, 95% CI 0.97–1.72; P = 0.08). Compared with incomplete resection, complete gross resection was associated with longer median OS durations: 56.0 months versus 37.8 months (HR 0.61, 95% CI 0.40–0.93). Complete gross resection did not, however, result in an OS benefit compared with chemotherapy alone: 56.0 months versus 64.7 months (HR 1.03, 95% CI 0.74–1.46). “We estimated OS durations of 22 months when we wrote the trial gY n a e c O lO g i c a l c a n c e r