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Outcomes After Combined Therapy Including Surgical Resection in Patients with Epithelial Ovarian Cancer Recurrence(s) Exclusively in Lymph Nodes

From the Departments of Surgery (CU, PM, SC, DC), Biostatistics (AR), Medical Oncology (PP, CL), Radiotherapy (CH-M), and Pathology (PD), Institut Gustave Roussy, Villejuif, France.

Correspondence: Address correspondence and reprint requests to: Philippe Morice, MD, Service de Chirurgie, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France; Fax: 33-1-42-11-52-13; E-mail: morice{at}igr.fr

Background: The aim was to study the prognosis for and survival of patients treated with combined therapy (including surgical resection) for nodal recurrences from epithelial ovarian cancer (EOC).

Methods: This was a retrospective study of a group of 12 patients with a recurrence from EOC, a priori, exclusively located in lymph node(s). All patients underwent surgical resection of nodal metastases, followed by adjuvant therapy.

Results: The median age of patients was 51 (range, 42–71) years. The initial disease stages were as follows: stage IA, n = 5; stage IIA, n = 1; and stage IIIC, n = 6. The median interval between the end of initial treatment and the nodal relapse was 21 (range, 6–72) months. The recurrence was located in the abdominal nodes in 10 patients (pelvic and/or para-aortic area) and was extra-pelvic in one patient, and the last patient had concomitant para-aortic and supraclavicular nodal involvement. Ten patients received postoperative chemotherapy and two had radiation therapy (one patient received both treatments). Eight patients relapsed and four did not. To date, three patients have died of the disease, three are alive with persistent disease, and six are alive and disease-free (including two patients who were treated by surgical resection after relapses twice in abdominal nodes). Five-year overall survival from the time of treatment of recurrent disease is 71% (confidence interval, 41%–90%).

Conclusions: The prognosis of patients with an a priori isolated nodal recurrence from EOC was good in this group of treated with surgical resection followed by chemoradiation or radiation therapy. This finding argues in favor of proposing surgical resection in such patients.

Key Words: Lymphadenectomy • Nodal recurrence • Ovarian cancer • Prognosis

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