The added value of chemotherapy after secondary cytoreductive surgery in unifocal versus multifocal first recurrent epithelial ovarian cancer: A systematic review

OBJECTIVE: This systematic review aims to evaluate the added value of chemotherapy after secondary cytoreductive surgery (SCS) on survival in patients with unifocal and multifocal first recurrent epithelial ovarian cancer (EOC). Moreover, it compares survival outcomes between unifocal and multifocal recurrences in treatment outcomes.

METHODS: A systematic search was conducted across PubMed, Embase, and the Cochrane Library identified 907 articles. Studies were selected if they involved patients with first recurrent EOC undergoing SCS, stratified by unifocal or multifocal recurrence. The primary outcomes were progression-free survival (PFS) and overall survival (OS).

RESULTS: No studies specifically addressed the added value of chemotherapy after SCS in unifocal versus multifocal first recurrent EOC. This systematic review identified eight studies examining PFS and OS in patients with unifocal and multifocal first recurrent EOC following SCS with chemotherapy. Findings consistently show that unifocal first recurrent EOC is associated with significantly improved PFS and OS compared to multifocal first recurrent EOC. However, the extent of the survival benefit varied. Six studies showed an advantage for unifocal recurrence on multivariate analyses, although two studies did not find statistically significant differences after adjusting for other variables.

CONCLUSION: This review shows that there is a knowledge gap regarding the added value of chemotherapy after complete SCS in first recurrent EOC. However, this review shows a survival advantage of unifocal over multifocal first recurrent EOC. There is a need for clinical trials to compare survival outcomes between unifocal and multifocal first recurrent EOC patients undergoing SCS alone or SCS with chemotherapy.