Combined treatment of patients with ovarian metastases from gastrointestinal cancer

Introduction. Ovarian metastases are characterized by low sensitivity to systemic therapy and are often associated with rapid progression and poor prognosis. Given the sensitivity of metastases from cancers of gastrointestinal tract to systemic therapy, the optimal choice of treatment strategy for ovarian metastases is one of the key problems in modern oncology. The aim of the work was to evaluate the effectiveness of bilateral adnexectomy in combination with chemotherapy in patients with ovarian metastases from cancers of gastrointestinal tract.

Aim. The aim of this study was to evaluate the effectiveness of bilateral adnexectomy in combination with chemotherapy in patients with metastatic ovarian lesions originating from gastrointestinal cancer.

Materials and methods. The study included 58 patients aged 37 to 77 years. The inclusion criteria were as follows: histologically verified gastrointestinal cancer; ECOG performance status grade 0–2. Patients with extensive peritoneal dissemination (P3) and brain metastases were excluded from the study. Patients were divided into 2 groups. Group A received combined treatment (adnexectomy / panhysterectomy in combination with drug therapy). Group Б received medications only. Group A was further divided into two subgroups, where Group A1 underwent change of chemotherapy regimen after surgery and Group A2 had no drug therapy adjustment following surgery.

Results. The median progression-free survival (PFS) in group A (with performed adnexectomy or panhysterectomy) was 12 months, while in group Б (no surgery was performed) the result was 4 months. Similar data were obtained when analyzing overall survival (OS) by groups. The median OS in group A was 19, notably these OS figures significantly exceeded the OS in group Б (7 months). Changing the drug therapy regimen after surgery did not demonstrate an increase in OS and PFS in patients of group A1 compared to group A2. Likewise, no statistical differences were found in OS and PFS when patients from group A underwent panhysterectomy as compared with bilateral adnexectomy. Meanwhile, panhysterectomy correlated with a prolonged postoperative recovery period and late systemic treatment resumption.

Conclusions. Combined treatment (bilateral adnexectomy + chemotherapy) significantly increases OS (19 months in group A and 7 months in group Б) and PFS (12 months and 4 months, respectively) in patients with metastatic ovarian disease compared to palliative chemotherapy. Thus, prerequisites for changing clinical practice in this category of patients have been found. The obtained results should be clarified in a randomized study. It is also worth noting that changing the line of chemotherapy is justified only in case of disease progression defined as an increase in the size of nonovarian metastatic foci. This statement should also be confirmed by the results of larger randomized studies.

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