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Simple Summary: Ovarian cancer ranks as the second most prevalent genital malignancy in women and leads to higher rates of mortality among gynecological cancers, often diagnosed at advanced stages with extensive metastases. Historically, treatment for recurrent ovarian cancer (ROC) has focused on managing peritoneal metastases, typically through aggressive surgery followed by systemic chemotherapy. Recent advancements have included secondary cytoreductive surgery and the use of hyperthermic intraperitoneal chemotherapy (HIPEC), aimed at improving survival but still debated due to variable outcomes in prior studies. This study conclusively finds that factors such as radical surgery, good performance status, platinum sensitivity, a positive AGO score, and a low Peritoneal Carcinomatosis Index (PCI) significantly enhance survival rates for patients with ROC undergoing HIPEC. It also highlights the predictive importance of platinum resistance and the AGO score in determining outcomes. Given these results, there is a strong recommendation for further prospective studies to validate these findings and to refine the criteria for selecting patients suitable for HIPEC, aiming to improve the treatment strategies and survival outcomes in this patient group. Background: Recurrent ovarian cancer (ROC) significantly challenges gynecological oncology due to its poor outcomes. This study assesses the impact of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) on ROC survival rates. Materials and Methods: Conducted at the Medical University of Lublin from April 2011 to November 2022, this retrospective observational study involved 71 patients with histologically confirmed ROC who underwent CRS and subsequent HIPEC. Results: The median overall survival (OS) was 41.1 months, with 3-year and 5-year survival rates post-treatment of 0.50 and 0.33, respectively. Patients undergoing radical surgery for primary ovarian cancer had a median OS of 61.9 months. The key survival-related factors included the Peritoneal Carcinomatosis Index (PCI) score, AGO score, platinum sensitivity, and ECOG status. Conclusions: The key factors enhancing ROC patients' survival include radical surgery, optimal performance status, platinum sensitivity, a positive AGO score, and a lower PCI. This study highlights the predictive value of the platinum resistance and AGO score in patient outcomes, underlining their role in treatment planning. Further prospective research is needed to confirm these results and improve patient selection for this treatment approach. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients diagnosed with epithelial ovarian cancer are usually treated with a combination of platinum-based chemotherapy and debulking surgery. Unfortunately, most of them will experience a recurrence of their disease, especially if diagnosed at an advanced stage. Patients with recurrence are typically re-treated with platinum-based chemotherapy if their disease recurs more than 6 months after the completion of previous chemotherapy. These patients are defined as having 'platinum sensitive' disease, while patients progressing less than 6 months after previous treatment are defined as 'platinum resistant'. It is known that patients who do not respond to platinum-based chemotherapy have a poorer prognosis and are expected to have shorter survival. Patients with platinum-sensitive disease will, at some point, become resistant to platinum, with increasing recurrence episodes. This study aims to compare the outcomes of patients who have primary platinum resistance at first treatment versus patients who acquire platinum resistance at a later stage of their illness. Objective: The goal of this study was to evaluate response to treatment and survival in epithelial ovarian cancer patients with acquired secondary platinum resistance (SPR) compared to patients with primary platinum resistance (PPR). Methods: Patients were categorized as PPR (patients with disease recurrence occurring during or <6 months after completing first-line platinum-based chemotherapy) and SPR (patients with previously platinum-sensitive disease that developed platinum resistance on subsequent treatments). Clinico-pathological variables and treatment outcomes were compared. Results: Of the 118 patients included in this study, 60 had PPR and 58 developed SPR. The SPR women had a significantly higher rate of optimal debulking during their upfront and interval operations, significantly lower CA-125 levels during their primary treatment, and a significantly higher complete and partial response rate to primary chemotherapy. Once platinum resistance appeared, no significant difference in survival was observed between the two groups. The median PFS was 2 months in the PPR group and 0.83 months in the SPR group (p = 0.085). Also, no significant difference was found in post-platinum-resistant relapse survival, with a median of 17.63 months in the PPR and 20.26 months in the SPR group (p = 0.515). Conclusions: Platinum resistance is an important prognostic factor in women with EOC. Patients with SPR acquire the same poor treatment outcome as with PPR. There is a great need for future research efforts to discover novel strategies and biological treatments to reverse resistance and improve survival. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer (OC) represents one of the most lethal cancers in women, with most cases diagnosed at an advanced stage. Recurrence occurs in around 70% of women within 5 years of diagnosis. In this era, in which maintenance therapy with PARP-inhibitors is the standard of care, most recurrent OC (ROC) patients are platinum-sensitive, and the choice of treatment becomes crucial. Randomized clinical trials investigated the role of surgery plus chemotherapy in the treatment of ROC, underlying an advantage in terms of progression-free survival and overall survival compared with chemotherapy alone. New recommendations concluded that platinum-sensitive OC patients should be assessed for eligibility for secondary cytoreductive surgery (SCS) in a gynecological oncology center. In selected cases, a minimally-invasive approach can be used. This narrative review is focused on minimally-invasive SCS and on the wide range of elements that must be considered in patient selection. The role of secondary cytoreductive surgery (SCS) in the treatment of recurrent ovarian cancer (ROC) has been widely increased in recent years, especially in trying to improve the quality of life of these patients by utilising a minimally-invasive (MI) approach. However, surgery in previously-treated patients may be challenging, and patient selection and surgical planning are crucial. Unfortunately, at the moment, validated criteria to select patients for MI-SCS are not reported, and no predictors of its feasibility are currently available, probably due to the vast heterogeneity of recurrence patterns. The aim of this narrative review is to describe the role of secondary cytoreductive surgery and, in particular, minimally-invasive procedures, in ROC, analyzing patient selection, outcomes, criticisms, and future perspectives. [ABSTRACT FROM AUTHOR]

Simple Summary: The vast majority of patients with epithelial ovarian carcinoma (OC) will relapse during the natural history of their disease. The role of cytoreductive surgery (CRS) in the treatment of recurrent disease has been emphasized by current studies. Adding hyperthermic intraperitoneal chemotherapy (HIPEC) has been evolved to improve DFS and OS. There are currently two convincing studies of HIPEC after complete cytoreduction in the treatment of primary OC, but there is little homogenous data on the role of HIPEC in platinum-sensitive recurrent ovarian cancer, its ideal compound, and its duration. The aim of this study was to analyze the bicentric experience with CRS + HIPEC in patients with platinum-sensitive recurrent epithelial OC in order to standardize the surgical approach. Thus, multimodal therapy was feasible with acceptable morbidity and mortality. Cisplatin monotherapy as a HIPEC compound and a 90 min HIPEC application proved to be the best option for regional additive treatment. Background: This bicentric study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer patients. Methods: The data of 88 patients with the first peritoneal recurrence of platinum-sensitive epithelial ovarian cancer who underwent CRS and HIPEC from a prospective HIPEC registry were retrospectively investigated. Endpoints were feasibility, chemotherapeutic compound, time of exposure, complications, and overall survival. Results: The median follow-up was 4.7 years (95%-CI 4.6–5.5). The median age was 55.8 years (IQR: 50.3–66.2). Eighty-four patients (95.5%) had high-grade serous histology. The median peritoneal cancer index was 12.0 (IQR: 7.0–20.5). Sixty-five patients (73.9%) had complete cytoreduction (CCR 0). Thirty-eight patients (43.2%) received HIPEC for 60 min, and fifty patients (56.8%) for 90 min. Eighteen patients (20.5%) had grade III to IV complications. One patient (1.1%) died perioperatively. The overall median survival was 43.1 months (95%-CI 34.1–52.2), and the 5-year survival rate was 39.7%. Only 90 min HIPEC and cisplatin were associated with survival. Conclusion: In well-selected patients with platinum-sensitive recurrent ovarian cancer, survival may correlate with complete CRS and 90 min cisplatin-based HIPEC. We confirmed the results of primary OC studies; therefore, this combination should be used for further analysis in the recurrent situation. [ABSTRACT FROM AUTHOR]

Simple Summary: Eligibility for secondary cytoreductive surgery (SCS) in ovarian cancer is dependent on multiple confounding factors. In this study, we evaluated the clinical characteristics of 262 patients with recurrent ovarian cancer to assess the impact of SCS on patient survival and establish simplified criteria for the selection of patients who would most likely be benefitted from SCS. We observed that the median survival was significantly longer in the patients who received SCS compared with those who received chemotherapy alone. As for the indication of the surgery, limited regional recurrence (single region or up to three regions with limited carcinomatosis) emerged as the simplified factor that could predict no residual disease after SCS. (1) Background: Multiple confounding factors influence the indications for secondary cytoreductive surgery (SCS) in patients with ovarian cancer (OC). We aimed to identify the factors associated with patients most likely to benefit from SCS. (2) Methods: We retrospectively reviewed the medical records of patients with recurrent ovarian cancer from 2003 to 2021. The potential factors influencing treatment outcomes and survival between patients who received chemotherapy alone and those who received SCS after recurrence were evaluated. (3) Results: Recurrent OC was identified in 262 patients, with a median age of 53 (20–80) years. Of these patients, 87.4% had an initial stage III/IV disease. Eighty-nine (34%) patients received SCS. The median survival was 41.0 (95% confidence interval [CI], 37.4–44.5) months and 88.0 (95% CI, 64.2–111.7) months in the chemotherapy and surgery groups, respectively. A multivariate analysis showed limited regional carcinomatosis (single region or up to three regions with limited carcinomatosis) (p = 0.045) as the only significant factor for predicting no residual disease after SCS. In platinum-sensitive recurrent patients with limited regional recurrence, the complete resection rate was 87.6%. (4) Conclusions: SCS had a significant impact on survival in the selected patient population. Limited regional recurrence (single region or up to three regions with limited carcinomatosis) may be a simple criterion for SCS in platinum-sensitive recurrent OC patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Recurrent ovarian-cancer patients face low 5-year survival rates despite chemotherapy. Oncologists may choose from a variety of guideline-recommended second-line therapeutic options without knowing which one works best. Thus, therapy alterations and adjustments are often required. We analyzed the response that 30 tumor lesions had to certain treatments in our patient-derived ovarian-cancer spheroid model. In addition, we characterized samples by immunohistochemical staining for new druggable molecular targets. Our results might help in tailoring future therapies for individual patients with recurrent ovarian cancer. Recurrent ovarian-cancer patients face low 5-year survival rates despite chemotherapy. A variety of guideline-recommended second-line therapies are available, but they frequently result in trial-and-error treatment. Alterations and adjustments are common in the treatment of recurrent ovarian cancer. The drug response of 30 lesions obtained from 22 relapsed ovarian cancer patients to different chemotherapeutic and molecular agents was analyzed with the patient-derived ovarian-cancer spheroid model. The profile of druggable biomarkers was immunohistochemically assessed. The second-line combination therapy of carboplatin with gemcitabine was significantly superior to the combination of carboplatin with PEGylated liposomal doxorubicin (p < 0.0001) or paclitaxel (p = 0.0007). Except for treosulfan, all nonplatinum treatments tested showed a lesser effect on tumor spheroids compared to that of platinum-based therapies. Treosulfan showed the highest efficacy of all nonplatinum agents, with significant advantage over vinorelbine (p < 0.0001) and topotecan (p < 0.0001), the next best agents. The comparative testing of a variety of treatment options in the ovarian-cancer spheroid model resulted in the identification of more effective regimens for 30% of patients compared to guideline-recommended therapies. Recurrent cancers obtained from different patients revealed profound interpatient heterogeneity in the expression pattern of druggable protein biomarkers. In contrast, different lesions obtained from the same patient revealed a similar drug response and biomarker expression profile. Biological heterogeneity observed in recurrent ovarian cancers might explain the strong differences in the clinical drug response of these patients. Preclinical drug testing and biomarker profiling in the ovarian-cancer spheroid model might help in optimizing treatment management for individual patients. [ABSTRACT FROM AUTHOR]