` @@@ @@@@p EN DB      & . 6Z F7 ry V go~Xq  Alexander1992 Berek1983 Berkowitz1992 Boente1998 Bristow1999 Brooks19922 Brooks20010 Buyse1996 Chang1999 Chi1998 Cohen2001  Covens2000 Culliford2001De Wever1998De Wever2000Decloedt1998Decloedt2000Eisenkop1993Eisenkop1995Eisenkop1998Eisenkop2000Elashoff1983 Favalli1996 Favalli2000 Fleming2000 Florack2001Friedman1995Friedman1998Friedman2000 Geisinger2000 Goodman1992 Graeff2001h Guillem2001 Hacker1983 Hackl1999 Harlow19922 Heintz1996 Hoskins1998 Hunter1992 Hunter1994 Ilson2001  Im2001 Kapp1999 Kapp1999 Karlan19999 Kelsen20010 Kemeny20010 Knapp1992 Kobierska1996  Kuhn2001 Lacave19966 Lagasse1983 Lagasse1999Leuchter1999 Loggie2000 Lowy2001 Luesley1995Maggioni19966 McGuire2001 McQuellon2000 Montz1999 Muto19929 Nalick19939 Nardi1996 Nieberg1983O'Reilly20011 Odicino2000 Pachyn2001h Paterson2001 Paty20011 Pecorelli1996  Pecorelli2000 Petru1999 Pickel1999iPortilla1999 Poschauko1999 Renard19966  Rosenshein2001 Russell2000 Rutke2001 Saltz2001  Schmalfeldt2001Schwartz20011 Sharma20010 Sheets19922 Soutter1992 Soutter1994 Spathe2001 Spirtos2000 Steller1992 Stratton2001Stucklschweiger1999 Sugarbaker1999 Teng19939 Tidy20012 Tjalma19989 Tjalma20000 Ulm2001 van Dam1998 van Dam2000 Van Gramberen1998 Van Gramberen2000 vanderBerg1996Vangeene1995 vanLent1996 Vergote1998 Vergote2000 von Hundelshausen2001 Wang19939 Wang19951 Wang19981 Winter1999i Wong20010 Wong200101999i Wong20010999i Wong20010999i Wong200109i Wong20010999i Wong200109i Wong200109i Wong20010   Authors`Journals Keywords                                < |`Alexander, N. D. Berek, J. S.Berkowitz, R. S. Boente, M. P.Bristow, R. E. Brooks, A. D. Brooks, S. Buyse, M. Chang, D. Chi, D. S. Cohen, A. M. Covens, A. L.Culliford, A. T. th De Wever, I. Decloedt, J.Eisenkop, S. M.Elashoff, R. M. Favalli, G.Fleming, R. A. Florack, G.Friedman, R. L.Geisinger, K. R.Goodman, H. M. Graeff, H.Guillem, J. G. Hacker, N. F. Hackl, A. Harlow, B. L.Heintz, A. P. M.Hoskins, W. J. Hunter, R. W. Ilson, D. H. Im, D. D. Kapp, D. S. Kapp, K. S. Karlan, B. Y. Kelsen, D. P. Kemeny, N. E. Knapp, R. C. Kobierska, A. Kuhn, W. Lacave, A. J.Lagasse, L. D.Leuchter, R. S. Loggie, B. W. Lowy, A. M. Luesley, D. Maggioni, A.McGuire, W. P.McQuellon, R. P. Montz, F. J. Muto, M. G. Nalick, R. H. Nardi, M.Nieberg, R. K.O'Reilly, E. M. Odicino, F. Pachyn, D.Paterson, M. E. L. Paty, P. B. Pecorelli, S. Petru, E. Pickel, H.Portilla, A. G. Poschauko, J. Renard, J.Rosenshein, N. B.Russell, G. B. Rutke, S. Saltz, L. B.Schmalfeldt, B.Schwartz, G. K. Sharma, S. Sheets, E. E.Soutter, W. P. Spathe, K.Spirtos, N. M. Steller, M.Stratton, J. F.Stucklschweiger, G. F.Sugarbaker, P. H. Teng, N. N. Tidy, J. A. Tjalma, W. Ulm, K. van Dam, P.Van Gramberen, M.vanderBerg, M. E. L. Vangeene, P. vanLent, M. Vergote, I.Vergote, I. B.von Hundelshausen, B. Wang, H. J. Winter, R. Wong, W. D.  Am J Obstet Gynecol Am SurgAmerican SurgeonAnn Surg Oncol Annals of Medicine Ann. Med.$Annals of Oncology Ann. Oncol.0-Annals of Surgical Oncology Ann. Surg. Oncol. Cancer0+Cancer Treatment Reviews Cancer Treat. Rev.LGCurrent Opinion in Obstetrics & Gynecology Curr. Opin. Obstet. Gynecol. Gynecol Oncol($Gynecologic Oncology Gynecol. Oncol.HEInternational Journal of Gynecological Cancer Int. J. Gynecol. CancerObstet GynecolTPObstetrics and Gynecology Clinics of North America Obstet. Gynecol. Clin. N. Am.("Seminars in Oncology Semin. Oncol. World J SurgWorld Journal of Surgery  *Meta-Analysis*Neoplasm Metastasis *Omentum*Perfusion, Regional2nd-2nd-look laparotomyadenocarcinoma adjuvant AdolescenceAdultAgedAged, 80 and over84Antibiotics, Antineoplastic/*administration & dosageD>Antineoplastic Combined Chemotherapy Protocols/therapeutic use appendectomy$Appendiceal Neoplasms/pathology ascitesAscites/complications aspirator cancercancer figo-iii carcinomaCarcinoma/*surgery0*Carcinoma/complications/mortality/*surgery,&Carcinoma/mortality/pathology/*surgeryCase-Control Studies chemotherapyChemotherapy, AdjuvantChi-Square Distribution cisplatin85Colorectal Neoplasms/drug therapy/*pathology/*surgerycombination chemotherapyCombined Modality Therapycomparing cisplatincyclophosphamide cytoreductioncytoreductive surgerydebulking surgeryDisease-Free Survival dna contentdose-intensity doxorubicinElectrocoagulationEvaluation Studies experience factorsFeasibility Studies Female figo stage follow-upFollow-Up Studies free interval4/Gastrointestinal Neoplasms/mortality/*pathologygrade,(Gynecologic Surgical Procedures/*methods gynecologic-oncology-groupHeat/*therapeutic useHuman impact intervalintervention debulking$intervention debulking surgery$Intestinal Neoplasms/pathologyivkrukenberg tumor Laser SurgeryLogistic Modelslong-term survivallook laparotomyMale management Meta-Analysis Methods Middle Age miliary("Mitomycin/*administration & dosage morbidityMultivariate Analysis neoadjuvantneoadjuvant chemotherapyNeoplasm Metastasis Neoplasm Recurrence, Local(#Neoplasm Recurrence, Local/*surgery@:Neoplasm Recurrence, Local/drug therapy/mortality/*surgeryNeoplasm StagingNeoplasm, Residualovarian cancerovarian carcinoma Ovarian Neoplasms/*surgery82Ovarian Neoplasms/complications/mortality/*surgery41Ovarian Neoplasms/drug therapy/mortality/*surgery4.Ovarian Neoplasms/mortality/pathology/*surgery paclitaxel Peritoneal Neoplasms/*surgery84Peritoneal Neoplasms/drug therapy/*secondary/surgery4/Peritoneal Neoplasms/mortality/surgery/*therapyperitoneal seeding phase-i$ Platinum/administration & dosage Postoperative Complications prediction primary cytoreductive surgery Prognosisprognosis of ovarian prognosticprognostic factors Proportional Hazards ModelsProspective Studiesprospective trialspseudomyxoma peritoneiQuality of Life radiation- radiotherapy randomizedrandomized trialRegression Analysis Reoperation resectionresidual diseaseRetrospective Studies Risk FactorsSalvage Therapysecondary cytoreduction$secondary cytoreductive surgery Splenectomy stage-i stage-iii Stomach Neoplasms/pathologySupport, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. surgerysurgical debulkingsurgical management survivalSurvival Analysis Survival Rate therapy treatmentTreatment Outcometrial    2 t101-105$://A1995QJ65100018 Vangeene, P. Luesley, D.HAProspective Randomized Trials on Cytoreduction in Ovarian- CanceraAnnals of Medicine'@9CITY HOSP NHS TRUST,BIRMINGHAM B18 7QH,W MIDLANDS,ENGLANDiovarian carcinoma; cytoreduction; prospective trials long-term survival; 2nd-look laparotomy; prognostic factors; dna content; stage-iii; carcinoma; surgery; management; cisplatin; therapyOvarian cancer remains the main cause of death from gynaecological malignancy in England and Wales. Since the reports by Griffiths et al, in the 1970s that optimal cytoreduction to less than or equal to 1.5 cm is associated with an increase in survival there has been a gradual trend towards more radical surgery aimed at maximal tumour reduction. Since these first reports many others have made similar observations, so that now maximal surgical endeavour aimed at cytoreduction is almost standard practice. However, the majority of these reports are based on retrospective analysis, small numbers, poor standardization of treatment and other methodological inconsistencies. To date, no prospective randomized trials have been completed to confirm Griffiths's findings. The authors propose the case for a randomized trial before accepting a new and potentially morbid procedure as standard practice. Ann. Med.  1995 Febe271h$English Article QJ651 ANN MED ISI:A1995QJ65100018/431-436$://000078029000020oTNVergote, I. De Wever, I. Tjalma, W. Van Gramberen, M. Decloedt, J. van Dam, P.}Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: A retrospective analysis of 285 patientssGynecologic Oncologyprimary cytoreductive surgery; prognostic factors; randomized trial; stage-iii; cancer; survival; impact; management; prediction; morbidityuObjective. This study was aimed at comparison of neoadjuvant chemotherapy with primary debulking surgery in advanced ovarian carcinoma. Methods. Retrospective analysis of 285 patients with advanced ovarian carcinoma treated between 1980 and 1997 was performed. Results. In the period 1980-1988 all patients underwent primary debulking surgery and 82% were cytoreduced to less than 0.5 cm largest residual tumor mass (n = 112), Analysis of this group of patients showed that some subgroups of patients (e.g., Stage IV disease or a total metastatic tumor load of more than 1000 g prior to debulking surgery) had a poor survival despite cytoreduction to no or less than 1 g of total residual tumor load. The complication rate was high especially in the group with unfavorable prognosis (postoperative mortality, 6%). In the period 1989-1997 (n = 173) the patients were surgically evaluated to receive primary chemotherapy (43%) or primary debulking surgery (57%). Prognostic variables were similar for both treatment periods. The actuarial crude survival was higher in the second time period (3-year crude survival of 26% +/- 4.3 and 42% +/- 4.6 for the first and second time periods, respectively; P = 0.0001). The postoperative mortality was 0% during the second time period. From 1993 on, the decision to give neoadjuvant chemotherapy or to perform primary debulking surgery in patients with clinically obvious metastatic disease was made with the help of an open laparoscopy (n = 77). Median duration of the laparoscopy, blood loss, and hospital stay due to this procedure were 25 min, 10 ml, and 2 days. Primary and interval debulking surgery was performed in 36 and 63% of this subgroup of patients, respectively. Conclusion. In this retrospective analysis over two different time periods, crude survival was higher when treating about half of the patients with advanced ovarian carcinoma with primary chemotherapy instead of primary debulking surgery. The role of neoadjuvant chemotherapy should be evaluated in a prospective randomized study. (C) 1998 Academic Press.Gynecol. Oncol. 1998 Dec713' Univ Hosp Leuven, Dept Gynecol Oncol, Louvain, Belgium Univ Hosp Leuven, Dept Gynecol Oncol, Louvain, Belgium Univ Hosp Leuven, Dept Surg Oncol, Louvain, Belgium Univ Antwerp Hosp, Dept Gynecol Oncol, Antwerp, Belgium Vergote I Univ Hosp Leuven, Dept Gynecol Oncol, Louvain, Belgium*#English Article 156XX GYNECOL ONCOLISI:000078029000020 31-36$://000088758200007eXQVergote, I. B. De Wever, I. Decloedt, J. Tjalma, W. Van Gramberen, M. van Dam, P.nZTNeoadjuvant chemotherapy versus primary debulking surgery in advanced ovarian cancerSeminars in Oncologyztprimary cytoreductive surgery; surgical debulking; prognostic factors; residual disease; carcinoma; survival; impact Semin. Oncol. 2000 Jun273'>7Univ Hosp Leuven, Dept Gynecol Oncol, B-3000 Louvain, Belgium Univ Hosp Leuven, Dept Gynecol Oncol, B-3000 Louvain, Belgium Univ Hosp Leuven, Dept Surg Oncol, B-3000 Louvain, Belgium Univ Antwerp Hosp, Dept Gynecol Oncol, Antwerp, Belgium Vergote IB Univ Hosp Leuven, Dept Gynecol Oncol, B-3000 Louvain, Belgium*#English Article 7 344KV SEMIN ONCOLISI:000088758200007 : 811776492810 2001 Dec~xSurgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer 787-95BACKGROUND: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome. METHODS: Patients having surgical debulking and IP 5-fluoro-2'-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively. RESULTS: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m2 daily for 3 days) and IP leucovorin (240 mg/m2) with a median cycle number of 4 (range, 1-28). The median number of complications was 1 (range, 0-5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0-132 months). The median survival was 34 months (range, 2-132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection. CONCLUSIONS: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.'d]Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.Culliford, A. T. th Brooks, A. D. Sharma, S. Saltz, L. B. Schwartz, G. K. O'Reilly, E. M. Ilson, D. H. Kemeny, N. E. Kelsen, D. P. Guillem, J. G. Wong, W. D. Cohen, A. M. Paty, P. B. 1068-9265 Journal ArticleAnn Surg Oncollehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=117764928276298512 1993 NovhbPeritoneal implant elimination during cytoreductive surgery for ovarian cancer: impact on survival 224-9A case-control study was performed to evaluate the potential benefit of peritoneal and serosal implant elimination (PIE) during primary cytoreductive surgery for patients with Stage IIIC epithelial ovarian cancer. Peritoneal implant excision and/or ablation was accomplished with electrocautery, CO2 laser, sharp dissection, argon beam coagulator, and cavitron ultrasonic surgical aspirator. Three groups of patients were compared: Group A (7 patients); macroscopically disease-free after cytoreduction without needing PIE; Group B (26 patients); macroscopically disease-free after cytoreduction, including PIE; Group C (34 patients); macroscopic disease < or = 1 cm remaining exclusively on peritoneal surfaces with PIE not attempted. Each group had statistically equivalent mean ages, estimated blood loss, extent of disease, and variety of cytoreductive operations performed. Group B had a longer mean operating time than that of A or C (4.0 vs 2.8 hr P = 0.002). No serious morbidity occurred from PIE. Comparison of survival by log rank analysis and Cox proportional hazards regression shows a survival advantage for patients rendered free of macroscopic peritoneal implants (Group B vs Group C; P = 0.003). The result suggests that complete elimination of all visible peritoneal metastases might be of benefit during surgical cytoreduction for ovarian cancer if this renders the patient macroscopically disease-free. We also suggest the need of a randomized, prospective study to clarify the clinical role of PIE.'@:Center for Gynecologic Oncology, Encino, California 91436.<5Eisenkop, S. M. Nalick, R. H. Wang, H. J. Teng, N. N. 0090-8258 Journal Article Gynecol OncolCase-Control Studies Combined Modality Therapy Electrocoagulation Evaluation Studies Female Human Laser Surgery Middle Age *Neoplasm Metastasis *Omentum Ovarian Neoplasms/*surgery Peritoneal Neoplasms/*surgery Prognosisjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=82762988635065769 1995 Nov 1XQSecondary cytoreductive surgery for recurrent ovarian cancer. A prospective study1606-14 * #BACKGROUND. The prognosis for patients with recurrent epithelial ovarian cancer is poor. Most are treated with salvage chemotherapy. The role of secondary cytoreductive surgery is controversial. Hence, this prospective study was undertaken to determine the feasibility and benefit of secondary cytoreductive surgery before the administration of salvage chemotherapy. METHODS. Between 1990 and 1994, 36 patients with recurrent epithelial ovarian cancer underwent secondary surgical cytoreduction. All had prior primary cytoreductive surgery, platin-based chemotherapy, and had relapsed at least 6 months after completion of primary treatment. The goal was the excision of all macroscopic disease before initiation of chemotherapy or radiation therapy. Statistical analysis was undertaken to determine which clinical and pathologic variables influenced the feasibility of complete excision as well as morbidity, mortality, survival benefit, and quality of life resulting from secondary cytoreductive surgery. RESULTS. Thirty (83.0%) patients had complete surgical excisions. The probability of a complete excision was influenced by Gynecologic Oncology Group (GOG) performance status (0-2 vs. 3, P = 0.05) and size of largest tumor deposit (< 10 cm vs. > 10 cm, P = 0.03). Eleven (30.1%) patients experienced morbidity and 1 (2.8%) died postoperatively. Of 27 symptomatic patients with at least 3 months of follow-up, 26 (96.2%) had resolution or improvement of their symptoms. Of 25 followed for at least 6 months postoperatively, 23 (92.0%) had a GOG performance status of 0 or 1. Survival was adversely influenced by the administration of salvage chemotherapy before surgery (P = 0.02), a preoperative GOG performance status of 3 (P = 0.01), and a brief disease free interval after completion of primary treatment (P = 0.01). The median survival was extended for patients completely resected before salvage chemotherapy or radiation, compared with those with macroscopic residual disease remaining (43 vs. 5 months, P = 0.03). CONCLUSIONS. Complete secondary cytoreductive surgery for recurrent epithelial ovarian cancer is technically feasible and has an acceptable operative complication rate. Survival is significantly improved for patients having complete resection. Subsequent relief of symptoms and performance status are excellent.'>7Center for Gynecologic Oncology, Encino, CA 91436, USA.2+Eisenkop, S. M. Friedman, R. L. Wang, H. J..(0008-543x Clinical Trial Journal Article Cancer`YAged Combined Modality Therapy Feasibility Studies Female Follow-Up Studies Human Logistic Models Middle Age Neoplasm Recurrence, Local/drug therapy/mortality/*surgery Ovarian Neoplasms/drug therapy/mortality/*surgery Prognosis Proportional Hazards Models Prospective Studies Quality of Life Salvage Therapy Support, Non-U.S. Gov't Survival Ratejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8635065 @@     _ However, the majority of these reports are based on retrospective analysis, small numbers, poor standardization of treatment and other methodological inconsistencies. To date, no prospective randomized trials have been completed to confirm Griffiths's findings. The authors propose the case for a randomized trial before acceptineudomyxoma peritonei; 2nd-look laparotomy; prognostic factors; krukenberg tumor; carcinoma; survival; appendectomyThis article aims to cover current concepts and controversies in the surgical management of ovarian cancer. While there have been significant advances in the surgical management of vulval, cervical and even endometrial cancer there have been few developments in the surgical management of ovarian cancer. This situation is likely to continue until we get a clearer understanding of the natural history of this disease and better therapeutic options become available. (C) 2001 Harcourt Publishers Ltd.Cancer Treat. Rev. 2001 Apr272'No Gen Hosp, Dept Obstet & Gynaecol, Herries Rd, Sheffield S5 7AU, S Yorkshire, England No Gen Hosp, Dept Obstet & Gynaecol, Sheffield S5 7AU, S Yorkshire, England Stratton JF No Gen Hosp, Dept Obstet & Gynaecol, Herries Rd, Sheffield S5 7AU, S Yorkshire, England0)English Review 434AT CANCER TREATMENT REVHISI:000168793500004o Vn6828269o614m 1983 ApreB;Primary cytoreductive surgery for epithelial ovarian cancerf 413-20pjForty-seven patients with stage III or IV invasive epithelial carcinoma of the ovary underwent primary cytoreductive surgery at UCLA during the five-year period 1974 to 1979. Optimal cytoreduction (defined as largest residual tumor mass 1.5 cm or less in diameter) was achieved in 31 patients (66%), including ten of 14 (71%) who underwent laparotomy and biopsy before referral. Median survival for the suboptimal group was six months, compared with 18 months for patients whose largest residual disease was 0.5 to 1.5 cm, and 40 months if residual nodules were less than 0.5 cm (P less than .001). All patients in the suboptimal group died of disease from 22 months to seven years and four months postoperatively. Given the limited ability of chemotherapy to cure ovarian cancer, and the acceptable morbidity of extended operation, the availability of ideal initial surgical effort for patients with advanced stage disease may be the most important variable in current ovarian cancer care. Optimal cytoreduction is most effective in prolonging survival in patients first seen without clinical ascites or large metastatic disease.NHHacker, N. F. Berek, J. S. Lagasse, L. D. Nieberg, R. K. Elashoff, R. M. 0029-7844 Journal ArticlecObstet GynecolAdult Aged Ascites/complications Carcinoma/complications/mortality/*surgery Female Human Methods Middle Age Neoplasm Metastasis Ovarian Neoplasms/complications/mortality/*surgery Postoperative Complications Retrospective Studies Support, Non-U.S. Gov'tjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=6828269 8-11$://A1996UK63300003Heintz, A. P. M.F?Surgery in ovarian cancer: The concept of cytoreductive surgeryp0*Current Opinion in Obstetrics & Gynecology carcinoma\UCritical analysis of the collected evidence on cytoreductive surgery suggests a median survival benefit of 9-12 months in combination with platinum-based chemotherapy. Recently, a randomized study on the value of secondary cytoreduction showed a median survival benefit of 6 months for those with small residual disease after the second operation. Primary cytoreduction is feasible in approximately 70% of patients, with an acceptable level of morbidity. The reported evidence justifies a serious attempt at cytoreductive surgery at the first operation by an experienced gynaecological oncologist."Curr. Opin. Obstet. Gynecol. 1996 Feb81'UNIV UTRECHT,ACAD HOSP,GYNAECOL ONCOL CTR,HEIDELBERGLAAN 100,UTRECHT,NETHERLANDS Heintz APM UNIV UTRECHT,ACAD HOSP,GYNAECOL ONCOL CTR,HEIDELBERGLAAN 100,UTRECHT,NETHERLANDS4.English Article UK633 CURR OPIN OBSTET GYNECOLISI:A1996UK633000031531572] 166m29 1992 Feb0Meta-analysis of surgery in advanced ovarian carcinoma: is maximum cytoreductive surgery an independent determinant of prognosis? 504-11OBJECTIVE: If maximum cytoreductive surgery benefits the survival of women with advanced ovarian cancer, the median survival time of groups of such women will improve as the proportion of women undergoing maximum cytoreductive surgery is increased. STUDY DESIGN: Fifty-eight suitable studies that encompass 6962 patients with advanced ovarian cancer were identified. Multiple linear regression was used to analyze the effects on median survival time of the following variables: the proportion of each cohort undergoing maximum cytoreductive surgery, the use of platinum-containing chemotherapy, the dose intensity of chemotherapy, the proportion of each cohort with stage IV disease, and the year of publication of the study. RESULTS: Maximum cytoreductive surgery was associated with only a small improvement in median survival time, but platinum-containing chemotherapy improved median survival time substantially. Increased dose intensity also conferred a useful survival benefit. CONCLUSION: Cytoreductive surgery probably has only a small effect on the survival of women with advanced ovarian cancer. The type of chemotherapy used is more important.'xrInstitute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.4-Hunter, R. W. Alexander, N. D. Soutter, W. P.r.'0002-9378 Journal Article Meta-Analysis Am J Obstet GynecollAntineoplastic Combined Chemotherapy Protocols/therapeutic use Combined Modality Therapy Female Human Meta-Analysis Ovarian Neoplasms/drug therapy/mortality/*surgery Platinum/administration & dosage Prognosis Regression Analysis Survival Ratejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15315728059859  171m2. 1994 Aug3 Meta-analysisH 583-4 "Hunter, R. W. Soutter, W. P.0002-9378 Comment LetterAm J Obstet Gynecol.<6Female Human *Meta-Analysis Ovarian Neoplasms/*surgeryjdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8059859 759-+$://000172471200010m0*Im, D. D. McGuire, W. P. Rosenshein, N. B.0)Contemporary management of ovarian cancer82Obstetrics and Gynecology Clinics of North Americagynecologic-oncology-group; 2nd-look laparotomy; stage-iii; secondary cytoreduction; comparing cisplatin; adjuvant treatment; dose-intensity; phase-i; paclitaxel; carcinomaOvarian cancer is the leading cause of death from malignancies arising in the female genital tract. Contemporary management of ovarian cancer, including cytoreductive surgery and chemotherapy, is presented in this article. The roles of second-look laparotomy and secondary cytoreductive surgery are discussed. Various chemotherapeutic regimens are described, including intraperitoneal chemotherapy.$Obstet. Gynecol. Clin. N. Am.6 2001 Dect284G'Mercy Med Ctr, Gynecol Oncol Ctr, 301 St Paul Pl, Baltimore, MD 21202 USA Mercy Med Ctr, Gynecol Oncol Ctr, Baltimore, MD 21202 USA Im DD Mercy Med Ctr, Gynecol Oncol Ctr, 301 St Paul Pl, Baltimore, MD 21202 USAs60English Article 497TH OBSTET GYNECOL CLIN N AMERISI:000172471200010$ an carcinoma 30-38$://A1996VC79600007vanderBerg, M. E. L. vanLent, M. Buyse, M. Kobierska, A. Maggioni, A. Favalli, G. Lacave, A. J. Nardi, M. Renard, J. Pecorelli, S.The role of intervention debulking surgery in advanced epithelial ovarian cancer: An EORTC Gynecological Cancer Cooperative Group Studyu4-International Journal of Gynecological Cancerintervention debulking surgery; ovarian cancer cytoreductive surgery; randomized trial; chemotherapy; carcinoma; survival; cyclophosphamide; doxorubicin; cisplatin; interval; therapy Chemotherapy is only moderately effective against advanced epithelial ovarian cancer. Patients with large residual tumors after primary surgery seldom attain long-term survival with chemotherapy alone, whereas patients with an optimal primary cytoreduction have a median survival of about 5 years. It is not clear whether the survival benefit associated with optimal cytoreduction is related to the tumor reduction itself or simply to selection of good-prognosis patients. In this prospective, randomized study, the European Organization for Research and Treatment of Cancer/Gynecological Cancer Cooperative Group investigated the effect of intervention debulking surgery on progression-free and overall survival in patients with advanced epithelial ovarian cancer. Eligible patients had epithelial ovarian carcinoma, International Federation of Gynecology and Obstetrics stage IIB-IV disease, lesions >1 cm after primary surgery, a performance status less than or equal to 2, and were less than or equal to 75 years old. After three cycles of cyclophosphamide-cisplatin, patients with stable disease or a response to chemotherapy were randomly assigned to undergo debulking surgery or to undergo no surgery, followed by further cyclophosphamide-cisplatin therapy. The study end-points were progression-free survival and overall survival. Of the 278 patients evaluable for progression-free and overall survival, 140 underwent debulking surgery and 138 did not. All known prognostic factors were well balanced between the two groups. The median follow-up was 3.5 years (maximum, 5.7). At intervention debulking surgery, 65% of the patients had lesions measuring >1 cm. In 45% of these patients, the lesions were surgically reduced to <1 cm. Surgery was not associated with death or severe morbidity. Intraoperative complications were observed in 5% of patients, and mild postoperative complications were observed in 14%. Progression- free and overall survivals were both significantly longer for the patients assigned to intervention debulking surgery (P = 0.01). Median progression-free survival was 18 months for the surgery group and 13 months for the no-surgery group. At 2 years follow-up, 38% of surgery patients and 26% of those who did not have surgery were alive and free of disease progression. Median survivals were 26 months (surgery) and 20 months (no surgery), and the proportion of patients alive at 2 years was 56% and 46%, respectively. Debulking surgery was an independent prognostic factor in the multivariate analysis (P = 0.012). Overall, after adjustment for all prognostic factors, surgery reduced the risk of death by 33% (P = 0.008) and significantly lengthened both progression-free and overall survival.Int. J. Gynecol. Cancer 19966'ROTTERDAM CANC INST,DANIEL DEN HOED KLIN,POB 5201,NL-3008 AE ROTTERDAM,NETHERLANDS INT INST DRUG DEV,BRUSSELS,BELGIUM MED ACAD,GDANSK,POLAND OSPED SAN GERARDO,MONZA,ITALY UNIV BRESCIA,BRESCIA,ITALY UNIV OVIEDO,HOSP CENT ASTURIAS,E-33080 OVIEDO,SPAIN REGINA ELENA INST CANC RES,ROME,ITALY EORTC DATA CTR,BRUSSELS,BELGIUM vanderBerg MEL ROTTERDAM CANC INST,DANIEL DEN HOED KLIN,POB 5201,NL-3008 AE ROTTERDAM,NETHERLANDS2,English Article 1 VC796 INT J GYNECOL CANCERISI:A1996VC79600007 400-407$://000082708100013vlfKapp, K. S. Kapp, D. S. Poschauko, J. Stucklschweiger, G. F. Hackl, A. Pickel, H. Petru, E. Winter, R.The prognostic significance of peritoneal seeding and size of postsurgical residual in patients with stage III epithelial ovarian cancer treated with surgery, chemotherapy, and high- dose radiotherapyGynecologic Oncologyovarian carcinoma; prognostic factors; radiotherapy; miliary peritoneal seeding primary cytoreductive surgery; long-term survival; radiation- therapy; figo stage; follow-up; carcinoma; cyclophosphamide; experience; cisplatin; grade7ztObjective. The aim of this study was to retrospectively analyze the prognostic importance of age, histologic type and grade, ascites, lymph node status, size and type of postoperative residual disease, and radiation dose on disease-specific (DSS) and progression-free survival (PFS) in stage III epithelial ovarian cancer patients who had been treated with radical surgery, postoperative chemotherapy, and high-dose radiotherapy. Methods. Consolidation radiotherapy including whole abdominal radiation, pelvic, and upper abdominal boosts was employed in 46 patients who showed no evidence of residual or progressive disease after completion of multiagent chemotherapy. The median follow-up for all patients was 36 months and 103 months for patients at risk. The prognostic impact of pretreatment and treatment parameters on DSS and PFS was tested in univariate and multivariate analyses. Results, The 5-year DSS and PFS rates for all patients were 38 and 33%, and for patients with 0-less than or equal to 2 cm residual tumor 65 and 61%, respectively, In univariate analysis, initial peritoneal seeding (both: P = 0.02), ascites (P = 0.03; 0.01), size of residual (0-less than or equal to 2 cm vs >2 cm), and residual miliary subdiaphragmatic (MDS) and localized peritoneal seeding (LPS) in the upper abdomen (P = 0.0002; 0.0003) were significantly correlated with DSS and PFS. Dose of radiation (less than or equal to 30 vs >30 Gy) correlated with DSS only (P = 0.02). In multivariate analysis size of residual disease (0-less than or equal to 2 cm vs >2 cm and/or MDS or LPS) remained the only independent prognostic factor for DSS and PFS (both; P = 0.001). Conclusion, Patients with localized peritoneal seeding who were rendered free of disease elsewhere had an outcome equally poor as that of patients with gross residuals (>2 cm) in the upper abdomen. If our findings can be confirmed, attempted resection of all localized seeding in patients who are otherwise cytoreducible to no or minimal residual disease may be considered in combination with Taxol- containing regimens as are now being utilized for patients with gross disease. (C) 1999 Academic Press.Gynecol. Oncol. 1999 Sep743'Graz Univ, Sch Med,Clin Radiol, Div Radiat Oncol, Dept Radiol, Auenbruggerpl 32, A-8036 Graz, Austria Graz Univ, Sch Med,Clin Radiol, Div Radiat Oncol, Dept Radiol, A-8036 Graz, Austria Graz Univ, Sch Med, Dept Obstet & Gynecol, A-8036 Graz, Austria Stanford Univ, Sch Med, Dept Radiat Oncol, Stanford, CA 94305 USA Kapp KS Graz Univ, Sch Med,Clin Radiol, Div Radiat Oncol, Dept Radiol, Auenbruggerpl 32, A-8036 Graz, Austria*#English Article 238JX GYNECOL ONCOLISI:000082708100013 269-274$://000089317000001v Covens, A. L.sD=Critique of surgical cytoreduction in advanced ovarian canceroGynecologic Oncologysurgery; cytoreduction; ovarian cancer combination chemotherapy; randomized trial; neoadjuvant chemotherapy; debulking surgery; free interval; carcinoma; survival; cisplatin; morbidity; aspiratorlDue in most part to the abundant retrospective evidence suggesting that surgical cytoreduction is essential to the management of advanced ovarian cancer, most clinicians do not question its application. Irrespective, there are many who still doubt its value, given its unique role in ovarian cancer, in comparison to other solid tumors. While many papers have extolled the virtues of debulking surgery, few have taken the opposing view. This paper attempts to expose the weaknesses in the current available data regarding surgical cytoreduction in advanced ovarian cancer. By reviewing the retrospective data, the theoretical benefits of surgery, cellular kinetics, the fallacies of residual disease, interval debulking surgery, and neoadjuvant chemotherapy, a critique of debulking surgery is made. Issues surrounding perioperative morbidity and its impact on quality of life have not been adequately addressed. Despite the need for randomized trials of surgery in advanced ovarian cancer, they are unlikely to occur. The window of opportunity with respect to studying the questions on the optimal timing, degree of aggressiveness, and patient selection for surgery has likely passed. Biases and ethical issues based upon the data cited in this paper have and will continue to hamper our ability to fully elaborate the benefits of surgery with respect to survival and quality of life. (C) 2000 Academic Press.Gynecol. Oncol. 2000 Sep783'Univ Toronto, Toronto Sunnybrook Reg Canc Ctr, Sunnybrook & Womens Coll Hlth Sci Ctr, Div Gynecol Oncol,Dept Obstet & Gynecol, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada Univ Toronto, Toronto Sunnybrook Reg Canc Ctr, Sunnybrook & Womens Coll Hlth Sci Ctr, Div Gynecol Oncol,Dept Obstet & Gynecol, Toronto, ON M4N 3M5, Canada Covens AL Univ Toronto, Toronto Sunnybrook Reg Canc Ctr, Sunnybrook & Womens Coll Hlth Sci Ctr, Div Gynecol Oncol,Dept Obstet & Gynecol, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada60English Editorial Material 1 354EN GYNECOL ONCOLISI:000089317000001Friedman, R. L. Wang, H. J. 0090-8258 Journal Article Gynecol OncolF?Carcinoma/mortality/pathology/*surgery Feasibility Studies Female Gynecologic Surgical Procedures/*methods Human Logistic Models Middle Age Neoplasm Staging Neoplasm, Residual Ovarian Neoplasms/mortality/pathology/*surgery Proportional Hazards Models Prospective Studies Risk Factors Survival Analysis Treatment Outcomejdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9600815  2585-2591$://000171966700013 tmKuhn, W. Rutke, S. Spathe, K. Schmalfeldt, B. Florack, G. von Hundelshausen, B. Pachyn, D. Ulm, K. Graeff, H.Neoadjuvant chemotherapy followed by tumor debulking prolongs survival for patients with poor prognosis in International Federation of Gynecology and Obstetrics Stage IIIC ovarian carcinoman Cancerneoadjuvant chemotherapy; ascites; prognosis of ovarian carcinoma; prognostic factors primary cytoreductive surgery; cancer figo-iii; therapy; adenocarcinoma; morbidity; resection; ivr BACKGROUND. Patients with advanced ovarian carcinoma of International Federation of Gynecology and Obstetrics (FIGO) Stage IIIC should be treated by radical surgical tumor debulking with the goal of complete tumor resection. Prolonged median survival can be achieved in those patients entirely free of tumor after surgery by the administration of postsurgical platinum/taxane-based chemotherapy regimens. However, residual tumor is present in the majority of patients, which limits survival prognosis, Different therapy approaches should be utilized to improve prognosis in these patients. Neoadjuvant chemotherapy could induce "downstaging" of the tumor and thus improve operability. Here, evidence of large ascites volume (> 500 mL) can be used to identify those patients who could benefit from neoadjuvant chemotherapy. METHODS. in a prospective, nonrandomized Phase II study, 31 patients with advanced FIGO Stage IIIC ovarian carcinoma and large ascites volume (> 500 mL) received 3 cycles of platinum/taxane-based combination chemotherapy, followed by tumor debulking surgery and 3 additional cycles of platinum/taxane-based combination chemotherapy. During the same period, 32 patients with advanced FIGO Stage IIIC ovarian carcinoma and large ascites volume (> 500 mL) received conventional therapy (tumor debulking surgery followed by 6 cycles of platinum/taxane-based combination chemotherapy). The two groups were investigated and compared with respect to tumor resection rates, blood transfusion requirements, morbidity, and mortality during surgery, duration of surgery, and median survival. RESULTS. The tumor resection rate in the patient group receiving neoadjuvant chemotherapy was significantly higher (P = 0.04) than that of the conventionally treated group; the median survival time of 42 months versus 23 months also was significantly longer (P = 0.007). Time spent in surgery, blood transfusion requirements, morbidity, and mortality during surgery were not significantly different. CONCLUSIONS. Patients with advanced ovarian carcinoma of FIGO Stage IIIC who will benefit only marginally from conventional therapy can be identified by evidence of large ascites volume. Higher tumor resection rates and longer median survival can be achieved in these patients by the use of neoadjuvant chemotherapy. A prospective randomized multicenter study currently is being performed by the Society for Gynecological Oncology in Germany to confirm these findings. (C) 2001 American Cancer Society. Cancer 2001 Nov 159210'Univ Ulm, Frauenklin, Prittwitzstr 43, D-89075 Ulm, Germany Tech Univ Munich, Klinikum Rechts Isar, Frauenklin, D-8000 Munich, Germany Tech Univ Munich, Chirurg Klin & Poliklin, D-8000 Munich, Germany Tech Univ Munich, Klinikum Rechts Isar, Anasthesiol Klin, D-8000 Munich, Germany Inst Med Stat & Epidemiol, Munich, Germany Kuhn W Univ Ulm, Frauenklin, Prittwitzstr 43, D-89075 Ulm, Germany"English Article 488ZG CANCERISI:000171966700013n326-334$://000074143000009.'Boente, M. P. Chi, D. S. Hoskins, W. J.jcThe role of surgery in the management of ovarian cancer: Primary and interval cytoreductive surgerySeminars in Oncologystage-iii; debulking surgery; combination chemotherapy; 2nd- look laparotomy; randomized trial; carcinoma; survival; cisplatin; cyclophosphamide; doxorubicin Semin. Oncol. 1998 Jun253'yFox Chase Canc Ctr, Dept Surg Oncol, Gynecol Oncol Sect, 7701 Burholme Ave, Philadelphia, PA 19111 USA Fox Chase Canc Ctr, Dept Surg Oncol, Gynecol Oncol Sect, Philadelphia, PA 19111 USA Mem Sloan Kettering Canc Ctr, Dept Surg, Gynecol Serv, New York, NY 10021 USA Boente MP Fox Chase Canc Ctr, Dept Surg Oncol, Gynecol Oncol Sect, 7701 Burholme Ave, Philadelphia, PA 19111 USAe& English Review ZT936 SEMIN ONCOLISI:000074143000009s278-287$://000079015900003NHBristow, R. E. Montz, F. J. Lagasse, L. D. Leuchter, R. S. Karlan, B. Y.VOSurvival impact of surgical cytoreduction in stage IV epithelial ovarian cancerGynecologic OncologyRKdebulking surgery; residual disease; free interval; carcinoma; chemotherapyh Objective. The aim of this study was to evaluate the influence of surgical cytoreduction on survival in patients with Stage IV epithelial ovarian cancer and to determine the survival impact of debulking extrahepatic disease in the subgroup of patients with liver metastasis. Methods. Medical records were retrospectively reviewed for all women with International Federation of Gynecology and Obstetrics Stage IV ovarian cancer treated between 1/1/82 and 12/31/94. Clinical information abstracted included age at diagnosis, performance status, histologic subtype, tumor grade, Stage IV criteria, ascites volume, predominant peritoneal tumor pattern, surgical procedures performed, hepatic tumor residuum, extrahepatic tumor residuum, and postoperative complications. Optimal surgical status was defined as residual disease sl cm. Chemotherapy treatment and follow-up were recorded. Survival analysis and comparisons were performed using the Kaplan-Meier method and the log-rank test. The Cox proportional hazards regression model was used to identify independent variables associated with an improved survival rate. Results. There were 84 women with Stage IV ovarian cancer and complete operative and postoperative information available. Median age at diagnosis was 61 years (range 26-85 years). Performance status was less than or equal to 2 in 83% of patients (70/84). Papillary serous histology was found in 44/84 patients (52%) and 55 patients (65%) had grade 3 tumors. Thirty-seven of 84 patients (44%) had parenchymal liver metastasis and 32/84 (38%) had malignant pleural effusion. Overall median survival was 18.1 months and was highly correlated with performance status (P = 0.002), predominant peritoneal tumor pattern (P = 0.0002), and the number of chemotherapy regimens received (P = 0.0039). Primary surgical cytoreduction was attempted in all patients and 25/84 (30%) achieved optimal status. Median survival of optimally cytoreduced patients was 38.4 months, compared to 10.3 months for patients with suboptimal residual disease (P = 0.0004). In patients with liver metastasis, optimal extrahepatic cytoreduction was achieved in 46% (17/37). Six of 37 patients (16%) underwent optimal resection of both extrahepatic and hepatic disease and had a median survival of 50.1 months, compared to a median survival of 27.0 months for the 11 patients (30%) with optimal extrahepatic dis-ease but suboptimal residual hepatic tumor. Twenty patients (54%) were left with both suboptimal residual extrahepatic and hepatic disease and had a median survival of 7.6 months (P = 0.0001). Optimal debulking surgery and performance status retained significance as independent predictors of survival on multivariate analysis. Conclusions. Optimal surgical debulking and performance status appear to be important determinants of survival in patients with Stage IV epithelial ovarian cancer. Even in patients with unresectable liver metastasis, optimal debulking of extrahepatic disease is associated with a significant survival advantage, (C) 1999 Academic Press.Gynecol. Oncol. 1999 Mar723'Cedars Sinai Med Ctr, Dept Obstet & Gynecol, Div Gynecol Oncol, Los Angeles, CA 90048 USA Cedars Sinai Med Ctr, Dept Obstet & Gynecol, Div Gynecol Oncol, Los Angeles, CA 90048 USA Univ Calif Los Angeles, Sch Med, Los Angeles, CA 90024 USA Johns Hopkins Med Inst, Div Gynecol Oncol, Dept Gynecol & Obstet, Baltimore, MD 21205 USA Bristow RE Cedars Sinai Med Ctr, Dept Obstet & Gynecol, Div Gynecol Oncol, Los Angeles, CA 90048 USA*#English Article 174CE GYNECOL ONCOLISI:000079015900003*  103-108$://000073987900005n2+Eisenkop, S. M. Friedman, R. L. Wang, H. J.tComplete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: A prospective studyGynecologic Oncologyhalong-term survival; combination chemotherapy; cisplatin; carcinoma; cyclophosphamide; doxorubicinlObjective. Despite correlation between the completeness of surgical cytoreduction and survival for patients with advanced ovarian cancer, relatively few undergo complete cytoreduction. This study was initiated to prospectively determine the ability to surgically eliminate all visible disease in patients with stage IIIC and IV epithelial ovarian cancer and the associated impact on survival. Methods. Between 1990 and 1996, 163 consecutive patients underwent primary cytoreduction. The goal was the excision or ablation of all visible disease prior to initiation of systemic platinum-based combination chemotherapy. A multivariate analysis determined which clinical and pathologic variables influenced the probability of achieving complete cytoreduction (logistic regression) and survival (Cox proportional hazards model). Results. One hundred thirty-nine patients (85.3%) underwent removal of all visible tumor, 22 (13.5%) had cytoreduction to less than or equal to 1 cm residual disease, and 2 (1.2%) had unresected bulky disease. The median and estimated 5-year survival for the entire cohort was 54 months and 48%, respectively. The probability of achieving complete cytoreduction was influenced independently by the preoperative Gynecologic Oncology Group performance status (0-1 vs 2-3, P = 0.04), the number of mesenteric and intestinal serosal implants (less than or equal to 75 vs >75 implants, P = 0.005), and stage (IIIC vs IV, P = 0.006). The probability of survival was independently influenced by age (less than or equal to 61 vs >61 years, P = 0.003), volume of ascites (less than or equal to 1 vs >1 liter, P = 0.01), stage (IIIC vs IV, P = 0.04), histology (clear cell and mucinous vs all other, P = 0.03), and the completeness of cytoreductive operation (complete vs incomplete cytoreduction, P = 0.02). Conclusions. Complete cytoreduction is possible for the majority of patients and improves survival, even compared to operations with minimal (less than or equal to 1 cm) residual disease. Unless their medical condition prohibits anesthesia and surgery, patients with advanced epithelial ovarian cancer should undergo primary cytoreductive surgery with the intention of complete tumor removal. (C) 1998 Academic Press.Gynecol. Oncol.X 1998 May6920'@9Encino Tarzana, Womens Canc Ctr, 5525 Etiwanda Ave,Suite 311, Tarzana, CA 91356 USA Encino Tarzana, Womens Canc Ctr, Tarzana, CA 91356 USA Univ Calif Los Angeles, Sch Publ Hlth, Dept Biomath, Los Angeles, CA 90095 USA Eisenkop SM Encino Tarzana, Womens Canc Ctr, 5525 Etiwanda Ave,Suite 311, Tarzana, CA 91356 USA*#English Article ZR541 GYNECOL ONCOLISI:00007398790000510618617881 2000 Jan 1ztThe role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma 144-53<5BACKGROUND: This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma. METHODS: One hundred six patients with a disease free interval (DFI) > 6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival. RESULTS: Eighty-seven patients (82.1%) underwent removal of all visible tumor. The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (< 10 cm ?90.0% vs. > 10 cm ?66.7%; P = 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given ?64.3% vs. chemotherapy not given ?93.8%; P = 0.001), and preoperative Gynecologic Oncology Group performance status (0 ?100%, 1 ?91.4%, 2 ?82.4%, and 3 ?47.4%; P = 0.001). Survival was influenced by the DFI after primary treatment (6-12 months ?median, 25.0 months vs. 13-36 months ?median, 44.4 months vs. > 36 months ?median, 56.8 months; P = 0.005), the completeness of cytoreduction (visibly disease free ?median, 44.4 months vs. any residual disease ?median, 19.3 months; P = 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given ?median, 24.9 months vs. chemotherapy not given ?median, 48.4 months; P = 0.005), and the largest size of recurrent tumor (< 10 cm ?median, 37.3 months vs. > 10 cm ?median, 35.6 months; P = 0.04). CONCLUSIONS: Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.'F@Womens' Cancer Center: Encino-Tarzana, Tarzana, California, USA.4.Eisenkop, S. M. Friedman, R. L. Spirtos, N. M. 0008-543x Journal Article CancerAdult Aged Aged, 80 and over Carcinoma/*surgery Disease-Free Survival Female Human Middle Age Multivariate Analysis Neoplasm Recurrence, Local/*surgery Ovarian Neoplasms/*surgery Prospective Studies Reoperation Survival Analysis Treatment Outcomelehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=106186171526516n463B 1992 Sepeb\The role of cytoreductive surgery in the management of stage IV epithelial ovarian carcinoma 367-71@:Patients with Stage IV epithelial ovarian carcinoma are generally treated in the same manner as are patients with disease confined to the abdomen--cytoreductive surgery followed by combination chemotherapy. Between 1980 and 1990, 35 women with histologically or cytologically documented Stage IV ovarian carcinoma were treated in this fashion. Sixteen women (45%) underwent optimal initial cytoreductive surgery, defined as less than 2 cm maximum residual disease. Eleven of the 19 women undergoing suboptimal initial procedures underwent interval cytoreduction after two to four cycles of chemotherapy, with 7 achieving an optimal status after the interval procedure. Overall, 23 of 35 patients (66%) were successfully cytoreduced to less than 2 cm either initially or at an interval procedure. Thirty-one of the 35 patients received combination regimens containing platinum as part of their initial therapy. Kaplan-Meier survival curves demonstrated no significant difference in survival between those groups of women cytoreduced intervally or initially, or between those groups of women optimally cytoreduced at some point during their initial therapy and those who were not. The 5-year survival for the entire group was less than 5%, with no significantly prolonged survival seen in those patients undergoing successful cytoreduction.'ztDivision of Gynecologic Oncology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115.rkGoodman, H. M. Harlow, B. L. Sheets, E. E. Muto, M. G. Brooks, S. Steller, M. Knapp, R. C. Berkowitz, R. S.o 0090-8258 Journal Articlea Gynecol OncollChemotherapy, Adjuvant Female Follow-Up Studies Human Middle Age Neoplasm Staging Ovarian Neoplasms/drug therapy/mortality/*surgery Retrospective Studies Splenectomy Survival Analysis,jdhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1526516 ,x2+Portilla, A. G. Sugarbaker, P. H. Chang, D.Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic featuresWorld Journal of Surgery 1999231t 23-9^XAssuming that peritoneal carcinomatosis is a local/regional dissemination of disease, a treatment strategy utilizing cytoreductive surgery and intraperitoneal chemotherapy was developed to treat colon cancer. In an attempt to improve knowledge of the mechanisms controlling abdominal and pelvic recurrences and for better selection of patients for reoperation, we studied those patients who had a second-look surgery following cytoreduction for peritoneal carcinomatosis from colorectal cancer. A group of 18 patients with symptoms and signs of recurrent peritoneal carcinomatosis were treated with reoperative surgery after definitive cytoreduction and intraperitoneal chemotherapy. An analysis of clinical features of these patients was performed using survival as an endpoint for evaluation of prognosis. The data suggest that the clinical features to be used to select patients for a second-look procedure after prior cytoreduction were the completeness of resection at the time of initial cytoreduction (p = 0.04) and the completeness of resection at the time of the second look (p = 0.066). In addition, a limited extent of peritoneal carcinomatosis distribution found at the time of the second look predicted a favorable result. A new objective assessment of peritoneal carcinomatosis, the peritoneal cancer index, was found to be of help during patient selection (p = 0.066). We concluded that second-look surgery with potential curative intent should be considered in patients who had a complete initial cytoreduction and those in whom total removal of the recurrence is judged possible at the time of the second look. At the time of abdominal exploration, a limited distribution and volume of peritoneal carcinomatosis as defined by the peritoneal cancer index should be considered. Palliative debulking procedures should be used to alleviate symptoms in other patients.111-118$://000168793500004c4.Stratton, J. F. Tidy, J. A. Paterson, M. E. L.0)The surgical management of ovarian cancergCancer Treatment Reviewsovarian cancer; surgical management secondary cytoreductive surgery; intervention debulking surgery; stage-i; pseudomyxoma peritonei; 2nd-look laparotomy; prognostic factors; krukenberg tumor; carcinoma; survival; appendectomyThis article aims to cover current concepts and controversies in the surgical management of ovarian cancer. While there have been significant advances in the surgical management of vulval, cervical and even endometrial cancer there have been few developments in the surgical management of ovarian cancer. This situation is likely to continue until we get a clearer understanding of the natural history of this disease and better therapeutic options become available. (C) 2001 Harcourt Publishers Ltd.Cancer Treat. Rev. 2001 Apr272'No Gen Hosp, Dept Obstet & Gynaecol, Herries Rd, Sheffield S5 7AU, S Yorkshire, England No Gen Hosp, Dept Obstet & Gynaecol, Sheffield S5 7AU, S Yorkshire, England Stratton JF No Gen Hosp, Dept Obstet & Gynaecol, Herries Rd, Sheffield S5 7AU, S Yorkshire, England0)English Review 434AT CANCER TREATMENT REVHISI:000168793500004o H TMLoggie, B. W. Fleming, R. A. McQuellon, R. P. Russell, G. B. Geisinger, K. R.,Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal originAmerican Surgeon 2000666d 561-8vNo standard effective treatment exists for peritoneal carcinomatosis of gastrointestinal origin. The pharmacokinetic advantage of intraperitoneal chemotherapy and the synergy of heat and certain anticancer agents have prompted researchers to investigate intraperitoneal hyperthermic chemotherapy in treating disseminated peritoneal cancers. We have conducted a large Phase II trial to determine the safety and efficacy of aggressive cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) in treating peritoneal carcinomatosis of gastrointestinal origin. Patients with disseminated peritoneal carcinomatosis of gastrointestinal origin with or without malignant ascites were eligible. After aggressive surgical debulking, patients were administered a 2-hour heated (40.5 degrees C) intraperitoneal perfusion with mitomycin C. The major response variable monitored was overall survival. Patients were assessed for toxicity after IPHC administration using the National Cancer Institute Common Toxicity Criteria. Eighty-four patients with peritoneal carcinomatosis of gastrointestinal origin were evaluated for survival and toxicity (colon, n = 38; appendix, n = 22; stomach, n = 19; other gastrointestinal, n = 5). Thirty-nine (46%) patients had malignant ascites at the time of therapy. The operative mortality (30-day) was 6 per cent. Hematologic toxicity was the most common toxicity but was of mild to moderate severity (7 and 4% of patients had grade 3/4 white blood cell or platelet toxicity, respectively). The overall median survival was 14.3 months. The median survival of patients with peritoneal carcinomatosis of appendiceal, colorectal, and gastric origins were 31.1+, 14.6, and 10.1 months, respectively. Significant differences in median survival were seen in patients without and with malignant ascites (27.7 vs 7.6 months; P = 0.0004) and R0/R1 (complete gross tumor resection) versus R2 (gross residual tumor) surgical resection status (28.5+ vs 10.8 months, P = 0.0002). These data suggest that aggressive cytoreductive surgery with IPHC using mitomycin C is safe and effective in treating peritoneal carcinomatosis of gastrointestinal origin. Additional studies and broader applications of this treatment are encouraged.754-755$://000172657800004 Lowy, A. M.EjdSurgery as adjuvant therapy? The treatment of peritoneal metastases from gastrointestinal malignancy"Annals of Surgical OncologyAnn. Surg. Oncol. 2001 Dec 8P10 500ZD ANNALS SURG ONCOLOGYISI:000172657800004P141-144$://000090112800021,%Pecorelli, S. Odicino, F. Favalli, G. HAOvarial cancer: best timing and applications of debulking surgeryiAnnals of Oncology^Wprimary cytoreductive surgery; combination chemotherapy; carcinoma; survival; cisplatin Ann. Oncol. 200011'Univ Brescia, Spedali Civili, Dept Obstet & Gynecol, Div Gynecol Oncol, Brescia, Italy Univ Brescia, Spedali Civili, Dept Obstet & Gynecol, Div Gynecol Oncol, Brescia, Italy Pecorelli S Univ Brescia, Spedali Civili, Dept Obstet & Gynecol, Div Gynecol Oncol, Brescia, Italy(!English Article 3 368JA ANN ONCOLISI:000090112800021i and the synergy of heat and certain anticancer agents have prompted researchers to investigate intraperitoneal hyperthermic chemotherapy in treating disseminated peritoneal cancers. We have conducted a large Phase II trial to determine the safety and efficacy of aggressive cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) in treating peritoneal carcinomatosis of gastrointestinal origin. Patients with disseminated peritoneal carcinomatosis of gastrointestinal origin with or without malignant ascites were eligible. After aggressive surgical debulking, patients were administered a 2-hour heated (40.5 degrees C) intraperitoneal perfusion with mitomycin C. The major response variable monitored was overall survival. Patients were assessed for toxicity after IPHC administration using the National Cancer Institute Common Toxicity Criteria. Eighty-four patients with peritoneal carcinomatosis of gastrointestinal origin were evaluated for survival and toxicity (colon, n = 38; appendix, n = 22; stomach, n = 19; other gastrointestinal, n = 5). Thirty-nine (46%) patients had malignant ascites at the time of therapy. The operative mortality (30-day) was 6 per cent. Hematologic toxicity was the most common toxicity but was of mild to moderate severity (7 and 4% of patients had grade 3/4 white blood cell or platelet toxicity, respectively). The overall median survival was 14.3 months. The median survival of patients with peritoneal carcinomatosis of appendiceal, colorectal, and gastric origins were 31.1+, 14.6, and 10.1 months, respectively. Significant differences in median survival were seen in patients without and with malignant ascites (27.7 vs 7.6 months; P = 0.0004) and R0/R1 (complete gross tumor resection) versus R2 (gross residual tumor) surgical resection status (28.5+ vs 10.8 months, P = 0.0002). These data suggest that aggressive cytoreductive surgery with IPHC using mitomycin C is safe and effective in treating peritoneal carcinomatosis of gastrointestinal origin. Additional studies and broader applications of this treatment are encouraged.'tmDepartment of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.TMLoggie, B. W. Fleming, R. A. McQuellon, R. P. Russell, G. B. Geisinger, K. R. 0003-1348 Journal ArticleAm SurgAdolescence Adult Aged Aged, 80 and over Antibiotics, Antineoplastic/*administration & dosage Appendiceal Neoplasms/pathology Female Gastrointestinal Neoplasms/mortality/*pathology Heat/*therapeutic use Human Intestinal Neoplasms/pathology Male Middle Age Mitomycin/*administration & dosage *Perfusion, Regional Peritoneal Neoplasms/mortality/surgery/*therapy Prospective Studies Stomach Neoplasms/pathology Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S.lehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10888132141-144$://000090112800021,%Pecorelli, S. Odicino, F. Favalli, G. HAOvarial cancer: best timing and applications of debulking surgeryiAnnals of Oncology^Wprimary cytoreductive surgery; combination chemotherapy; carcinoma; survival; cisplatin Ann. Oncol. 200011'Univ Brescia, Spedali Civili, Dept Obstet & Gynecol, Div Gynecol Oncol, Brescia, Italy Univ Brescia, Spedali Civili, Dept Obstet & Gynecol, Div Gynecol Oncol, Brescia, Italy Pecorelli S Univ Brescia, Spedali Civili, Dept Obstet & Gynecol, Div Gynecol Oncol, Brescia, Italy(!English Article 3 368JA ANN ONCOLISI:000090112800021i