BACKGROUND AND PURPOSE: 

• It remains unclear if secondary surgery is helpful in women with recurrent ovarian cancer 
• Harter et al. (NEJM 2021) sought to determine whether cytoreductive surgery followed by chemotherapy resulted in longer overall survival vs chemotherapy alone 

METHODS: 

• Randomized Controlled Trial 
  • DESKTOP III Study  
• Participants 
  • Recurrent ovarian cancer (epithelial)  
  • AGO score used to evaluate probability for complete resection  
  • Complete resection at initial surgery 
  • First relapse after a platinum-free interval of ≥6 months  
• Interventions 
  • Secondary cytoreductive surgery followed by platinum-based chemotherapy  
  • Platinum-based chemotherapy alone
• Study design 
  • 1:1 Randomization  
  • Required sample size based on accrual period of 3 years and a 3-year follow-up period: 408 patients would be needed | Power of 80% (assuming 10% drop out rate)  
• Primary outcome 
  • Overall survival  
• Secondary outcomes 
  • Quality of life at baseline, visit 1 (at 6 months), or visit 2 (at 12 months) 
  • Prognostic factors for survival  

RESULTS: 

• Total of 407 patients  
  • Cytoreduction: 206  
  • Chemotherapy: 201 
• Complete resection in 75.5% of cytoreduction group 
• Median overall survival 
  • Cytoreduction: 53.7 months  
  • Chemotherapy only: 46.0 months 
  • Hazard ratio for death (HR): 0.75 (95% CI, 0.59 to 0.96); P=0.02
• Complete resection was associated with most favorable outcome 
  • Median overall survival: 61.9 months 
• Quality of life measures 
  • No difference between groups for global health status, quality of life, or any functional subscale  
• Surgical complications 
  • No perioperative mortality within 30 days postop 

CONCLUSION: 

• For women with ovarian cancer recurrence, cytoreductive surgery followed by chemotherapy resulted in longer overall survival vs chemotherapy alone 
• The authors state 

All patients with a first relapse after a platinum-free interval of at least 6 months may be evaluated to assess whether surgery is an option 

Eligible patients could receive counseling about the options for cytoreductive surgery in centers of gynecologic oncology that have experience in surgery for relapsed ovarian cancer 

 In contrast, patients who have a high probability of incomplete resection on the basis of disease or clinical characteristics should not be exposed to a potentially harmful surgical treatment 

Learn More – Primary Sources: 

Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer 

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