Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival?

Amanda Nickles Nickles Fader, Jennifer Bergstrom, Amelia Jernigan, Edward J. Tanner, Kara Long Roche, Rebecca Stone, Kimberly Levinson, Stephanie Ricci, Stephanie Wethingon, Tian-Li Wang, Ie Ming Shih, Bin Yang, Gloria Zhang, Deborah Kay Armstrong, Stephanie Gaillard, Chad Michener, Robert DeBernardo, Peter G. Rose

Research output: Contribution to journalArticle

Abstract

Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41. months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - 2017

Fingerprint

Carcinoma
Survival
Hormones
letrozole
Therapeutics
Drug Therapy
Neoplasms
Medical Overuse
Progesterone Receptors
Tamoxifen
Estrogen Receptors
Retrospective Studies
Recurrence

Keywords

  • Cytoreductive surgery
  • Hormonal therapy
  • Low-grade serous carcinoma
  • Ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma : Reducing overtreatment without compromising survival? / Nickles Fader, Amanda Nickles; Bergstrom, Jennifer; Jernigan, Amelia; Tanner, Edward J.; Roche, Kara Long; Stone, Rebecca; Levinson, Kimberly; Ricci, Stephanie; Wethingon, Stephanie; Wang, Tian-Li; Shih, Ie Ming; Yang, Bin; Zhang, Gloria; Armstrong, Deborah Kay; Gaillard, Stephanie; Michener, Chad; DeBernardo, Robert; Rose, Peter G.

In: Gynecologic Oncology, 2017.

Research output: Contribution to journalArticle

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title = "Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival?",
abstract = "Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2{\%}. Ninety six percent of tumors expressed estrogen receptors, while only 32{\%} expressed progesterone receptors. Letrozole was administered post operatively in 55.5{\%} cases, anastrozole in 37.1{\%} and tamoxifen in 7.4{\%}. After a median follow up of 41. months, only 6 patients (22.2{\%}) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8{\%} and 96.3{\%}, respectively, and 3-year PFS and OS were 79.0{\%} and 92.6{\%}, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.",
keywords = "Cytoreductive surgery, Hormonal therapy, Low-grade serous carcinoma, Ovarian cancer",
author = "{Nickles Fader}, {Amanda Nickles} and Jennifer Bergstrom and Amelia Jernigan and Tanner, {Edward J.} and Roche, {Kara Long} and Rebecca Stone and Kimberly Levinson and Stephanie Ricci and Stephanie Wethingon and Tian-Li Wang and Shih, {Ie Ming} and Bin Yang and Gloria Zhang and Armstrong, {Deborah Kay} and Stephanie Gaillard and Chad Michener and Robert DeBernardo and Rose, {Peter G.}",
year = "2017",
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T1 - Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma

T2 - Reducing overtreatment without compromising survival?

AU - Nickles Fader, Amanda Nickles

AU - Bergstrom, Jennifer

AU - Jernigan, Amelia

AU - Tanner, Edward J.

AU - Roche, Kara Long

AU - Stone, Rebecca

AU - Levinson, Kimberly

AU - Ricci, Stephanie

AU - Wethingon, Stephanie

AU - Wang, Tian-Li

AU - Shih, Ie Ming

AU - Yang, Bin

AU - Zhang, Gloria

AU - Armstrong, Deborah Kay

AU - Gaillard, Stephanie

AU - Michener, Chad

AU - DeBernardo, Robert

AU - Rose, Peter G.

PY - 2017

Y1 - 2017

N2 - Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41. months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.

AB - Objectives: Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT). Methods: A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated. Results: Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41. months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively. Conclusions: Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype.

KW - Cytoreductive surgery

KW - Hormonal therapy

KW - Low-grade serous carcinoma

KW - Ovarian cancer

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