The DESKTOP I trial proposed a score for the prediction of complete cytoreduction in recurrent ovarian cancer. Resectability was assumed if 3 factors were present: (1) complete resection at first surgery, (2) good performance status, and (3) absence of ascites. The DESKTOP II trial was planned to verify this hypothesis prospectively in a multicenter setting.
Participating centers prospectively enrolled all consecutive patients with platinum-sensitive first or second relapse. The score was applied to all patients, but centers were free to decide on therapy. All further therapies were documented, and the outcome of patients was analyzed. A 75% complete resection rate in 110 prospectively classified patients had to be achieved to confirm a positive predictive value of 2 or higher of 3 with 95% probability.
A total of 516 patients were screened within 19 months; of these, 261 patients (51%) were classified as score positive, and 129 patients with a positive score and first relapse were operated on. The rate of complete resection was 76%, thus confirming the validity of this score regarding positive prediction of complete resectability in 2 or more of 3 patients. Complication rates were moderate including second operations in 11% and perioperative mortality in 0.8%.
This score is the first prospectively validated instrument to positively predict surgical outcome in recurrent ovarian cancer. It can aid in the selection of patients who might benefit from secondary cytoreductive surgery and will be enrolled in the recently started randomized prospective DESKTOP III trial investigating the role of surgery in recurrent platinum-sensitive ovarian cancer.
*Department of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany; †Department of Gynecology & Gynecologic Oncology, Klinikum Essen Mitte, Essen, Germany; ‡Department of Gynecology & Obstetrics, Charité University, Campus Virchow, Berlin, Germany; §Coordinating Center for Clinical Trials, Marburg University, Marburg, Germany; ∥Department of Gynecology & Obstetrics, University of Freiburg, Freiburg, Germany; ¶Department of Oncology, Catholic University of Sacred Heart, Campobasso, Italy; #Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic; **Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ††Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium; ‡‡Department of Gynecology & Gynecologic Oncology, University of Vienna (AKH), Vienna, Austria; §§Department of Gynecology & Obstetrics, University of Munich Grosshadern, Munich, Germany; ∥∥Department of Gynecology & Obstetrics, University of Frankfurt, Frankfurt, Germany; ¶¶Department of Gynecology & Obstetrics, University of Bonn, Bonn, Germany; ##Department of Gynecology & Obstetrics, University of Ulm, Ulm, Germany; ***Department of Gynecology & Obstetrics, University of Dresden, Dresden, Germany; †††Department of Gynecology & Obstetrics, City Hospital Wolfsburg, Wolfsburg, Germany; ‡‡‡Royal Brisbane & Women's Hospital, Queensland Centre for Gynecological Cancer, Brisbane, Australia; §§§Department of Gynecology & Obstetrics, University Graz, Austria; ∥∥∥Department of Gynecology & Obstetrics, University Munich rdI, Munich, Germany.
Received September 20, 2010, and in revised form November 19, 2010.
Accepted for publication December 9, 2010.
Address correspondence and reprint requests to Philipp Harter, MD, Department of Gynecology & Gynecologic Oncology, Klinikum Essen Mitte, Henricistrasse 92, 45136 Essen, Germany. E-mail: firstname.lastname@example.org.
The authors thank Medac Oncology, Astra Zeneca, AGO, KKS Marburg, MITO, AGO-Austria, and NOGGO for financial and/or administrative support and A. du Bois, H.J Lück, W. Meier, and P. Harter for personal donations.