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Secondary Debulking in Recurrent Ovarian Cancer

Panelists: Bradley J. Monk, MD, FACS, FACOG, University of Arizona, Creighton University, & Arizona Oncology Practice of US Oncology; Ursula Matulonis, MD, Dana-Farber Cancer Institute; David OMalley, MD, The Ohio State University; Matthew Powell, MD, Washington University; Shannon N. Westin, MD, MPH, MD Anderson Cancer Center
Published: Thursday, Apr 26, 2018



Transcript: 

Bradley J. Monk, MD, FACS, FACOG: Before we get to PARP inhibitors, Shannon, is there a role for secondary surgery? Is there a role for doing another debulking when a patient gets a recurrent ovarian cancer?

Shannon N. Westin, MD, MPH: Traditionally, I think that we’ve always believed that. Some considerations include using it for a specific patient population that has a single site or just 2 small sites of disease that we deem resectable, or in a patient population that has had an extensive interval from their last platinum-based therapy. There are a few other factors, but we generally have thought, “Let’s take that patient back to the operating room and completely cytoreduce down to no gross residual disease, and then let’s complete the regimen with a platinum-based therapy.” Traditionally, that has been what we’ve looked at. We have several randomized trials that have either just reported some of their outcomes or are about to report outcomes, which I think will answer this question a little bit better in a more prospective way. But certainly, that has been something that we’ve offered patients.

David O’Malley, MD: The question that will remain is, is there a patient who will benefit from that? We look at these large trials, looking obviously at the continuum of the population. But also, as we look forward, in patients with a median survival—some patients of 10 years—we’re going to need to look at when or if to use surgery.

Bradley J. Monk, MD, FACS, FACOG: One of the things we don’t talk about is radiosurgery. In the old days, if you have a little thing next to the ureter, we’d cut her open, resect that piece of the ureter, and reimplant it. Now if I have that, I just do radiosurgery.

Matthew Powell, MD: SBRT 5 days a week.

Bradley J. Monk, MD, FACS, FACOG: Right. She didn’t even know she was treated, and it always goes away.

Matthew Powell, MD: We just completed our small prospective trial that looked at that intervention.

Bradley J. Monk, MD, FACS, FACOG: I think that’s something that we will unfortunately never study. But, to your point, the 5-day toxicity is negligible.

Matthew Powell, MD: I think your term, radiosurgery, is quite correct. We have reasonable disease control. It’s not perfect.

Bradley J. Monk, MD, FACS, FACOG: But it’s an option.

Matthew Powell, MD: And there’s still a surgical option if it fails.

David O’Malley, MD: Well, let’s not go there. There are options. There is minimally invasive surgery and the resection of that disease. You’re talking about, potentially, an option for other…

Bradley J. Monk, MD, FACS, FACOG: That’s all I’m saying.

Matthew Powell, MD: It’s just in our bag of tricks.

Ursula Matulonis, MD: Radiofrequency ablation procedures.

Bradley J. Monk, MD, FACS, FACOG: There you go.

Ursula Matulonis, MD: For something that’s stuck onto the liver, it’s certainly another way of doing it.

Transcript Edited for Clarity 

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Transcript: 

Bradley J. Monk, MD, FACS, FACOG: Before we get to PARP inhibitors, Shannon, is there a role for secondary surgery? Is there a role for doing another debulking when a patient gets a recurrent ovarian cancer?

Shannon N. Westin, MD, MPH: Traditionally, I think that we’ve always believed that. Some considerations include using it for a specific patient population that has a single site or just 2 small sites of disease that we deem resectable, or in a patient population that has had an extensive interval from their last platinum-based therapy. There are a few other factors, but we generally have thought, “Let’s take that patient back to the operating room and completely cytoreduce down to no gross residual disease, and then let’s complete the regimen with a platinum-based therapy.” Traditionally, that has been what we’ve looked at. We have several randomized trials that have either just reported some of their outcomes or are about to report outcomes, which I think will answer this question a little bit better in a more prospective way. But certainly, that has been something that we’ve offered patients.

David O’Malley, MD: The question that will remain is, is there a patient who will benefit from that? We look at these large trials, looking obviously at the continuum of the population. But also, as we look forward, in patients with a median survival—some patients of 10 years—we’re going to need to look at when or if to use surgery.

Bradley J. Monk, MD, FACS, FACOG: One of the things we don’t talk about is radiosurgery. In the old days, if you have a little thing next to the ureter, we’d cut her open, resect that piece of the ureter, and reimplant it. Now if I have that, I just do radiosurgery.

Matthew Powell, MD: SBRT 5 days a week.

Bradley J. Monk, MD, FACS, FACOG: Right. She didn’t even know she was treated, and it always goes away.

Matthew Powell, MD: We just completed our small prospective trial that looked at that intervention.

Bradley J. Monk, MD, FACS, FACOG: I think that’s something that we will unfortunately never study. But, to your point, the 5-day toxicity is negligible.

Matthew Powell, MD: I think your term, radiosurgery, is quite correct. We have reasonable disease control. It’s not perfect.

Bradley J. Monk, MD, FACS, FACOG: But it’s an option.

Matthew Powell, MD: And there’s still a surgical option if it fails.

David O’Malley, MD: Well, let’s not go there. There are options. There is minimally invasive surgery and the resection of that disease. You’re talking about, potentially, an option for other…

Bradley J. Monk, MD, FACS, FACOG: That’s all I’m saying.

Matthew Powell, MD: It’s just in our bag of tricks.

Ursula Matulonis, MD: Radiofrequency ablation procedures.

Bradley J. Monk, MD, FACS, FACOG: There you go.

Ursula Matulonis, MD: For something that’s stuck onto the liver, it’s certainly another way of doing it.

Transcript Edited for Clarity 
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