Allegheny Health Network Physician Research Points to Possible New Paradigm in Ovarian Cancer Treatment

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Journal of Clinical Oncology Research Looks at Value, Risk of Aggressive Surgery

Thomas Krivak, MD, Gynecologic Oncologist, Allegheny Health Network

"We believe further research is needed to determine whether, for patients with highly advanced cancer, chemotherapy should be used to shrink tumors prior to surgery."

Aggressive surgery to remove all visible disease in ovarian cancer patients may have little benefit for some patients whose cancer is highly advanced at diagnosis, according to a study published in today’s Journal of Clinical Oncology, led by Allegheny Health Network gynecologic oncologist Thomas C Krivak, MD.

Over the past decade, there has been a growing trend toward more aggressive surgery for ovarian cancer, as research has found significant survival benefit when all or nearly all visible cancer is removed, followed by a chemotherapy regimen.

However, the study of 2,655 ovarian cancer patients from hospitals around the country found that the initial extent of disease remains the biggest predictor of patient survival, even when all visible cancer is removed by the surgeon.

“We believe further research is needed to determine whether, for patients with highly advanced cancer, chemotherapy should be used to shrink tumors prior to surgery, to give the surgeon a better chance at removing all visible cancer,” Dr. Krivak said. “That would mark a paradigm shift in our treatment of ovarian cancer.”

“Our research also raises questions about how we can determine, pre-operatively, which patients are best suited to an aggressive surgical procedure to remove their cancer,” Dr. Krivak said. “This is a decision that needs to be made individually, with honest conversations between doctor and patient.”

Ovarian cancer is the most deadly gynecologic malignancy, with an estimated 21,980 diagnoses and 14,270 deaths in 2014. Most ovarian cancers are diagnosed when they are already well advanced, and five-year survival rates for late-stage cancer are low.

Women in the study with the highest pre-operative disease burden had an average progression-free survival time of 15 months, compared to 23 for those with moderate disease levels and 34 months for those with low levels of disease. Overall survival averaged 40 months for those with high levels of disease, 71 months for moderate levels and 86 months for those at low levels, the aggressiveness of surgery notwithstanding.

While research has shown that aggressive surgery results in a strong survival benefit, up to 25 percent of patients who undergo the surgery will suffer significant complications, and 1 to 2 percent will not survive, according to the study.

“Our research confirms that aggressive surgery is an effective strategy for patients with low to moderate disease burden at the time of surgery. However, those with a high disease burden see their cancer progress much more quickly despite successful surgery.” Dr. Krivak said. “The risk of adverse events related to surgery, along with the probability of removing all visible cancer, needs to be weighed when considering aggressive surgical treatment.”

The complete publication is available at the online Journal of Clinical Oncology.

About Allegheny Health Network
Allegheny Health Network is a western Pennsylvania-based integrated healthcare system that serves patients from across a five state region that includes Pennsylvania, Ohio, West Virginia, Maryland and New York. The Network’s Cancer Institute offers a complete spectrum of oncology care, including access to state-of-the-art technologies and new therapies being explored in clinical cancer trials.

The Network’s radiation oncology program is the largest in the country accredited by both the American Society for Radiation Oncology and the American College of Radiology and the first and only one in Pittsburgh to receive both accreditations.

Allegheny Health Network’s Cancer Institute collaborates with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, one of the nation’s 41 comprehensive cancer centers designated by the National Cancer Institute, for research, medical education and clinical services.
To schedule an appointment with an AHN oncologist, please call 412.DOCTORS or visit http://www.ahn.org/find-a-doctor.

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Dan Laurent