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

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

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Scopus citations

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)
Pages (from-to)85-91
Number of pages7
JournalGynecologic oncology
Volume147
Issue number1
DOIs
StatePublished - Oct 2017

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Fingerprint Dive into the research topics of 'Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival?'. Together they form a unique fingerprint.

Cite this