Variables Related to Adjuvant Chemotherapy and Response

Eisenkop and colleagues14 examined the effect of the use of salvage chemotherapy before attempting surgical cytoreduction. Patients who had not received salvage chemotherapy experienced improved survival after surgery for recurrence. The investigators also evaluated the effect of previous response to chemotherapy in the course of disease. They found that the patient's response or lack of response to platinum-based regimens had no effect on postoperative survival.

Because surgery alone is rarely curative, surgical cytoreduction is generally not attempted without a plan for administering postoperative chemotherapy. In the DESKTOP trial21 women who went on to receive platinum-based chemotherapy regimens after secondary cytoreduction experienced improved survival compared with patients who received other chemotherapy regimens (odds ratio 1.84; 95% confidence interval 1.13-3.01).

Most patients chosen for secondary cytoreduction have by definition platinum-sensitive disease and are candidates for retreatment with platinum-based regimens after surgery. It is difficult to conclude from the published literature whether patients who are not candidates for further platinum treatment will benefit from secondary cytoreduction. We recommend that patients considered for cytoreduction have further chemotherapy options for microscopic tumor control and eradication after surgery.

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