Robert Bristow, M.D., Director of the Kelly Gynecologic Oncology Service and the Johns Hopkins Ovarian Cancer Center of Excellence, and colleagues highlight the importance of referring patients with suspected ovarian cancer to expert centers for their first surgery. By combining multiple studies of patients with stage III or IV ovarian carcinoma (6,885 patients) Bristow et al showed that consistent referral of patients with apparent advanced ovarian cancer to expert centers for primary surgery may be the best means currently available for improving overall survival. Even with the use of platinum based chemotherapy, maximal (or optimal or complete) cytoreduction was one of the most powerful determinants of cohort survival among patients with stage III or IV ovarian carcinoma. While the influence of platinum dose-intensity upon survival was not statistically significant, maximal cytoreduction was associated with a 50% increase of actuarial survival.
PubMed medical study abstract: “Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis,”Bristow, R.E., Tomacruz, R.S., Armstrong, D.K., Trimble, E.L., Montz, F.J., Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD 21287-1248, USA. rbristo@jhmi.edu, J. Clin. Oncol. 2002 Mar 1;20(5):1248-59.
Full Text of medical study: Journal of Clinical Oncology, Vol. 20, Issue 5 (March), 2002: pp.1248-1259.
Additional medical studies:
- “Specialized Hospital Care Associated With Better Survival in Dutch Ovarian Cancer Patients.” Liz Savage, J Natl Cancer Inst 2008 100: 375
- “Factors associated with the suboptimal treatment of women less than 55 years of age with early-stage ovarian cancer;” Chan J, Kapp D, Shin J, et al.; Gynecologic Oncology. 2008;108: 95-99.
- “In treating ovarian cancer, a little-known specialist can make a big difference” by Laurie McGinley, Health Matters, Wall Street Journal, November 17, 2007. (.PDF download)
- “Predictors of comprehensive surgical treatment in patients with ovarian cancer;” Goff B, Matthews B, Larson E, et al.; CANCER May 15, 2007 , Vol. 109, No. 10, pp. 2031=2042.
- “Access to gynecologic oncologists and its impact on survival of women with epithelial ovarian cancer;” Chan JK et al.; Gynecol Oncol. 2007;104(3): Abstract 17.
COMMENT: If you were recently diagnosed with ovarian cancer, these studies suggest that you should seek treatment from a medical institution(s) that (i) utilizes Gynecologic Oncologists as an essential part of the cancer diagnosis and treatment process, (ii) utilizes surgeons that possess high-end expertise with respect to gynecologic oncology surgical procedures such as maximum cytoreduction (e.g., gynecologic oncology surgeons), and (iii) conducts a high volume of gynecologic oncology surgeries and procedures resulting in best outcome. Refer to the resources below.
- List of NCI-designated Cancer Centers.
- List of National Comprehensive Cancer Network Members.
- 2007 U.S. News & World List of Best U.S. Hospitals (click on each hospital to determine its gynecological sub-specialty rating).
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