human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined . Therefore , patient selection remains arbitrary and depends on the center ’s preference rather than on established selection criteria . The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer ( DESKTOP OVAR ) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer . Methods The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records . Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee ( AGO OC ) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003 . Results Two hundred and sixty-seven patients were included .  Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [ median 45.2 vs. 19.7 months ; hazard ratio ( HR ) 3.71 ; 95 % confidence interval ( CI ) 2.27–6.05 ; P < .0001 ] . Variables associated with complete resection were performance status ( PS ) [ Eastern Cooperative Oncology Group ( ECOG ) 0 vs. > 0 ; P < .001 ] , International Federation of Gynecology and Obstetrics ( FIGO ) stage at initial diagnosis ( FIGO I/II vs. III/IV , P = .036 ) , residual tumor after primary surgery ( none vs. present , P < .001 ) , and absence of ascites > 500 ml ( P < .001 ) . A combination of PS , early FIGO stage initially or no residual tumor after first surgery , and absence of ascites could predict complete resection in 79 % of patients . Conclusions Only complete resection was associated with prolonged survival in recurrent ovarian cancer . The identified criteria panel will be verified in a prospect i ve trial ( AGO-DESKTOP II ) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer AIMS The feasibility , morbidity and toxicity of an intensified surgical treatment strategy consisting of aggressive cytoreductive surgery , intra-operative intraperitoneal perfusion of cisplatin and hyperthermia were evaluated in women with recurrent ovarian cancer . METHODS Five heavily pre-treated patients with extensive abdominal tumour bulk entered this pilot study . In all cases aggressive cytoreduction leaving tumour remnants < 5 mm in diameter could be performed . This was followed intra-operatively by perfusion of the abdominal cavity with hyperthermic cisplatin 50 - 70 mg/m(2)for 90 min . During perfusion the intra-abdominal temperature was maintained at 40 degrees C. The median duration of surgery was 10 hours ( range 9 - 11 hours ) . RESULTS No major intra- or post-operative complications emerged . Median post-operative ileus ( resuming of soft diet ) was 11 days ( 9 - 13 days ) . The mean period of hospitalization was 25 days ( range 17 - 42 ) . Toxicity due to i.p . cisplatin was mainly metabolic and of grade 1 - 2 , while no nephrotoxicity was observed . The pharmacokinetics of cisplatin indicated that the maximum concentration of cisplatin measured in the perfusate was 15 times higher than in plasma . CONCLUSIONS We conclude that aggressive cytoreduction combined with hyperthermic intra-operative intraperitoneal cisplatin was feasible in a small group of heavily pre-treated ovarian cancer patients with extensive tumour bulk with acceptable morbidity and toxicity . Further studies are required in larger groups of patients to further establish the feasibility of this intensified treatment strategy . We stress that OVHIPEC is not a treatment modality on its own for advanced ovarian cancer . The effectiveness of OVHIPEC is likely to be dependent on the effectiveness of post-operative adjuvant chemotherapeutic regimens OBJECTIVE The aim of this study was to evaluate the utility of combined positron emission tomography/computed tomography ( PET/CT ) for identifying ovarian cancer tumor masses > or = 1 cm in patients with clinical ly occult recurrent disease by conventional CT imaging .  METHODS Twenty-two patients with epithelial ovarian cancer , rising serum CA125 levels , and negative or equivocal conventional CT imaging > or = 6 months after primary therapy underwent combined PET/CT imaging followed by surgical re assessment .  Fisher 's exact test was used to measure the ability of PET/CT to predict macroscopic disease > or = 1 cm . RESULTS The median patient age was 55 years , and 91 % of patients had FIGO Stage IIIC/IV disease . The median increase in serum CA125 was 24 U/ml ( range 10 to 330 U/ml ) . Conventional CT was reported as negative ( n = 15 ) or equivocal ( n = 7 ) in all cases . Eighteen patients were ultimately found to harbor recurrent ovarian cancer measuring > or = 1 cm at the time of surgery , with a median maximal tumor diameter of 2.3 cm ( range 1.5 to 3.2 cm ) . The overall patient-based accuracy of PET/CT  in detecting recurrent disease > or = 1 cm was 81.8 % , with a sensitivity of 83.3 % and positive predictive value of 93.8 % ( P = 0.046 ) . Of patients with recurrent ovarian cancer > or = 1 cm , complete cytoreduction to no gross residual tumor was accomplished in 72.2 % . CONCLUSION PET/CT imaging demonstrates high sensitivity and positive predictive value in identifying potentially resectable , macroscopic recurrent ovarian cancer among patients with biochemical evidence of recurrence and negative or equivocal conventional CT findings . In appropriately selected patients , early identification of macroscopic recurrent disease may facilitate complete surgical cytoreduction OBJECTIVE This study was undertaken to evaluate the role of secondary cytoreduction in patients with recurrent epithelial ovarian cancer . STUDY DESIGN Secondarily , cytoreduced patients were retrospectively analyzed with respect to the clinicopathologic variables . RESULTS A total of 64 patients were evaluated in this report . Multivariable analysis revealed 3 factors to be significant : optimal cytoreduction during primary ( P = .003 , odds ratio [ OR ] : 0.30 ; 95 % CI : 0.14 - 0.66 ) , secondary cytoreduction  ( P = .04 , OR : 0.47 ; 95 % CI : 0.22 - 0.99 ) , and the endometrioid histologic type ( P = .005 , OR : 0.09 ; 95 % CI : 0.02 - 0.48 ) . Intrinsic factors of the tumors ( grade , stage , age ) , size , and number of recurrent tumors were nonsignificant . CONCLUSION Secondary cytoreductive surgery should be offered in selected recurrent epithelial ovarian cancer patients . Further prospect i ve r and omized series are needed to determine specific recommendations OBJECTIVE The aim of this study was to evaluate the role of secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer with an apparent solitary intra-abdominal focus . METHODS We conducted a retrospective review of patients with epithelial ovarian cancer who underwent secondary cytoreduction for recurrence at the University of Texas M. D. And erson Cancer Center between 1985 and 1994 . Eligible patients included those who had a laparotomy to resect a tumor that was apparently solitary .  Cytoreductive surgery was defined as optimal if the diameter of the largest residual tumor was < or = 2 cm and suboptimal if > 2 cm . RESULTS Twenty-five patients met our eligibility criteria . Their mean age was 55 years ( range , 35 - 73 years ) . The median time from primary diagnosis to recurrence was 37.6 months . Tumor was found to be confined to a solitary site in 15 patients ( 60 % ) , to two sites in 6 ( 24 % ) , and to three or more sites in 4 ( 16 % ) . Surgical procedures included cytoreduction in 10 patients , intestinal resection in 8 , splenectomy in 3 , and limited biopsies in 4 . Secondary cytoreduction was optimal in 18 of 25 patients ( 72 % ) . The median post secondary cytoreduction survival was 25.1 months for patients who had suboptimal secondary cytoreduction compared with 56.9 months for those who had optimal cytoreduction ( P = 0.08 ) . CONCLUSIONS Secondary cytoreductive surgery for recurrent ovarian cancer at an apparently solitary intra-abdominal site result ed in optimal residual tumor in a high proportion of patients . Although there was no survival advantage for patients whose tumor was optimally debulked , there was a trend toward improved survival . A large prospect i ve r and omized trial of secondary cytoreduction for recurrence is recommended Aggressive surgical cytoreduction has been shown to have a positive impact on survival of patients with ovarian cancer . After first-line chemotherapy , 47 % of patients relapse within 5 years , and median survival after second line chemotherapy is 10—15 months . Adding intraperitoneal chemohyperthermia ( IPCH ) to surgical cytoreduction could further control ceolomic spread of disease . The aim of this study was to determine morbidity and mortality , regional relapse-free survival and , preliminarily , overall survival after combining cytoreductive surgery with IPCH for the treatment of peritoneal carcinomatosis from ovarian epithelial cancer relapsed after prior chemotherapy . Thirty women affected with such a relapse were included . Patients underwent extensive cytoreductive surgery including tumor resections and peritonectomy , followed by intraoperative IPCH with cisplatin . Complete surgical cytoreduction down to nodules less than 2.5 mm ( CC0—CC1 ) was obtained in 23 patients ( 77 % ) . One patient died postoperatively from a pulmonary embolism . Major postoperative morbidity was 5/30 ( 16.7 % ) . We registered one case of anastomotic leakage , a spontaneous ileum perforation , a postoperative cholecystitis , a hydrothorax , and one patient with bone marrow toxicity . Kaplan-Meier estimates of median locoregional relapse-free survival and median overall survival were 17.1 months and 28.1 months , respectively . Patients with CC0—CC1 had locoregional relapse-free and overall survival rates of 24.4 and 37.8 months , whereas the remainder had survival rates of 4.1 and 11.0 months . We concluded that cytoreductive surgery combined with IPCH is feasible with acceptable morbidity and mortality and seems to promise good results in selected patients affected with peritoneal carcinomatosis from ovarian cancer ABSTRACT Background Secondary surgical cytoreduction ( SCR ) represents a promising therapeutic strategy for patients affected by ovarian cancer disease recurrence . The aim of this prospect i ve observational trial was to analyze the role of SCR in patients with platinum-sensitive ovarian cancer . Methods Patients with platinum-sensitive ovarian cancer underwent SCR  by a single surgical team . Clinical and oncologic data were prospect ively recorded . A total of 47 patients underwent SCR from 1999 to 2003 . Results The mean operating time was 210 minutes , and mean blood loss was 500 mL. The most frequent surgical procedures carried out were splenectomy , lymphadenectomy , bowel resection , and extensive peritonectomy . Optimal cytoreduction was achieved in 41 patients . Thirty-seven patients had no visible tumor at the end of SCR . Overall median survival was 49 months . Patients who achieved optimal residual disease had a median survival of 61 months , whereas patients who had residual disease > 1 cm had a median survival of 19 months . Conclusions Positive CA-125 ( cancer antigen 125 ) was identified as a negative prognostic factor at multivariate analysis . After careful selection , optimal cytoreduction can be achieved in most patients who are subjected to SCR with acceptable morbidity . Residual tumor and CA-125 represent the most important prognostic factors OBJECTIVE The aim of this prospect i ve study was to evaluate the influence of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer . METHODS Between June 1993 and June 1999 , 149 patients after primary treatment underwent secondary cytoreductive surgery : 69 ( 46.3 % ) had recurrence-free interval ( RFI ) 7 - 12 months , 59 ( 39.6 % ) RFI 13 - 24 months , and 21 ( 14.1 % ) RFI > 24 months . Exclusion criteria included secondary cytoreduction during second-look laparotomy , interval cytoreduction , and palliative surgery in patients with intestinal obstruction or progressive disease . RESULTS The median follow-up was 27 months . According to multivariate analysis , RFI groups , prior chemotherapy combination , and residual tumor after secondary surgery were associated independently with overall survival . Resid 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined . Therefore , patient selection remains arbitrary and depends on the center ’s preference rather than on established selection criteria . The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer ( DESKTOP OVAR ) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer . Methods The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records . Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee ( AGO OC ) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003 . Results Two hundred and sixty-seven patients were included .  Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [ median 45.2 vs. 19.7 months ; hazard ratio ( HR ) 3.71 ; 95 % confidence interval ( CI ) 2.27–6.05 ; P < .0001 ] . Variables associated with complete resection were performance status ( PS ) [ Eastern Cooperative Oncology Group ( ECOG ) 0 vs. > 0 ; P < .001 ] , International Federation of Gynecology and Obstetrics ( FIGO ) stage at initial diagnosis ( FIGO I/II vs. III/IV , P = .036 ) , residual tumor after primary surgery ( none vs. present , P < .001 ) , and absence of ascites > 500 ml ( P < .001 ) . A combination of PS , early FIGO stage initially or no residual tumor after first surgery , and absence of ascites could predict complete resection in 79 % of patients . Conclusions Only complete resection was associated with prolonged survival in recurrent ovarian cancer . The identified criteria panel will be verified in a prospect i ve trial ( AGO-DESKTOP II ) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer AIMS The feasibility , morbidity and toxicity of an intensified surgical treatment strategy consisting of aggressive cytoreductive surgery , intra-operative intraperitoneal perfusion of cisplatin and hyperthermia were evaluated in women with recurrent ovarian cancer . METHODS Five heavily pre-treated patients with extensive abdominal tumour bulk entered this pilot study . In all cases aggressive cytoreduction leaving tumour remnants < 5 mm in diameter could be performed . This was followed intra-operatively by perfusion of the abdominal cavity with hyperthermic cisplatin 50 - 70 mg/m(2)for 90 min . During perfusion the intra-abdominal temperature was maintained at 40 degrees C. The median duration of surgery was 10 hours ( range 9 - 11 hours ) . RESULTS No major intra- or post-operative complications emerged . Median post-operative ileus ( resuming of soft diet ) was 11 days ( 9 - 13 days ) . The mean period of hospitalization was 25 days ( range 17 - 42 ) . Toxicity due to i.p . cisplatin was mainly metabolic and of grade 1 - 2 , while no nephrotoxicity was observed . The pharmacokinetics of cisplatin indicated that the maximum concentration of cisplatin measured in the perfusate was 15 times higher than in plasma . CONCLUSIONS We conclude that aggressive cytoreduction combined with hyperthermic intra-operative intraperitoneal cisplatin was feasible in a small group of heavily pre-treated ovarian cancer patients with extensive tumour bulk with acceptable morbidity and toxicity . Further studies are required in larger groups of patients to further establish the feasibility of this intensified treatment strategy . We stress that OVHIPEC is not a treatment modality on its own for advanced ovarian cancer . The effectiveness of OVHIPEC is likely to be dependent on the effectiveness of post-operative adjuvant chemotherapeutic regimens OBJECTIVE The aim of this study was to evaluate the utility of combined positron emission tomography/computed tomography ( PET/CT ) for identifying ovarian cancer tumor masses > or = 1 cm in patients with clinical ly occult recurrent disease by conventional CT imaging .  METHODS Twenty-two patients with epithelial ovarian cancer , rising serum CA125 levels , and negative or equivocal conventional CT imaging > or = 6 months after primary therapy underwent combined PET/CT imaging followed by surgical re assessment .  Fisher 's exact test was used to measure the ability of PET/CT to predict macroscopic disease > or = 1 cm . RESULTS The median patient age was 55 years , and 91 % of patients had FIGO Stage IIIC/IV disease . The median increase in serum CA125 was 24 U/ml ( range 10 to 330 U/ml ) . Conventional CT was reported as negative ( n = 15 ) or equivocal ( n = 7 ) in all cases . Eighteen patients were ultimately found to harbor recurrent ovarian cancer measuring > or = 1 cm at the time of surgery , with a median maximal tumor diameter of 2.3 cm ( range 1.5 to 3.2 cm ) . The overall patient-based accuracy of PET/CT  in detecting recurrent disease > or = 1 cm was 81.8 % , with a sensitivity of 83.3 % and positive predictive value of 93.8 % ( P = 0.046 ) . Of patients with recurrent ovarian cancer > or = 1 cm , complete cytoreduction to no gross residual tumor was accomplished in 72.2 % . CONCLUSION PET/CT imaging demonstrates high sensitivity and positive predictive value in identifying potentially resectable , macroscopic recurrent ovarian cancer among patients with biochemical evidence of recurrence and negative or equivocal conventional CT findings . In appropriately selected patients , early identification of macroscopic recurrent disease may facilitate complete surgical cytoreduction OBJECTIVE This study was undertaken to evaluate the role of secondary cytoreduction in patients with recurrent epithelial ovarian cancer . STUDY DESIGN Secondarily , cytoreduced patients were retrospectively analyzed with respect to the clinicopathologic variables . RESULTS A total of 64 patients were evaluated in this report . Multivariable analysis revealed 3 factors to be significant : optimal cytoreduction during primary ( P = .003 , odds ratio [ OR ] : 0.30 ; 95 % CI : 0.14 - 0.66 ) , secondary cytoreduction  ( P = .04 , OR : 0.47 ; 95 % CI : 0.22 - 0.99 ) , and the endometrioid histologic type ( P = .005 , OR : 0.09 ; 95 % CI : 0.02 - 0.48 ) . Intrinsic factors of the tumors ( grade , stage , age ) , size , and number of recurrent tumors were nonsignificant . CONCLUSION Secondary cytoreductive surgery should be offered in selected recurrent epithelial ovarian cancer patients . Further prospect i ve r and omized series are needed to determine specific recommendations OBJECTIVE The aim of this study was to evaluate the role of secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer with an apparent solitary intra-abdominal focus . METHODS We conducted a retrospective review of patients with epithelial ovarian cancer who underwent secondary cytoreduction for recurrence at the University of Texas M. D. And erson Cancer Center between 1985 and 1994 . Eligible patients included those who had a laparotomy to resect a tumor that was apparently solitary .  Cytoreductive surgery was defined as optimal if the diameter of the largest residual tumor was < or = 2 cm and suboptimal if > 2 cm . RESULTS Twenty-five patients met our eligibility criteria . Their mean age was 55 years ( range , 35 - 73 years ) . The median time from primary diagnosis to recurrence was 37.6 months . Tumor was found to be confined to a solitary site in 15 patients ( 60 % ) , to two sites in 6 ( 24 % ) , and to three or more sites in 4 ( 16 % ) . Surgical procedures included cytoreduction in 10 patients , intestinal resection in 8 , splenectomy in 3 , and limited biopsies in 4 . Secondary cytoreduction was optimal in 18 of 25 patients ( 72 % ) . The median post secondary cytoreduction survival was 25.1 months for patients who had suboptimal secondary cytoreduction compared with 56.9 months for those who had optimal cytoreduction ( P = 0.08 ) . CONCLUSIONS Secondary cytoreductive surgery for recurrent ovarian cancer at an apparently solitary intra-abdominal site result ed in optimal residual tumor in a high proportion of patients . Although there was no survival advantage for patients whose tumor was optimally debulked , there was a trend toward improved survival . A large prospect i ve r and omized trial of secondary cytoreduction for recurrence is recommended Aggressive surgical cytoreduction has been shown to have a positive impact on survival of patients with ovarian cancer . After first-line chemotherapy , 47 % of patients relapse within 5 years , and median survival after second line chemotherapy is 10—15 months . Adding intraperitoneal chemohyperthermia ( IPCH ) to surgical cytoreduction could further control ceolomic spread of disease . The aim of this study was to determine morbidity and mortality , regional relapse-free survival and , preliminarily , overall survival after combining cytoreductive surgery with IPCH for the treatment of peritoneal carcinomatosis from ovarian epithelial cancer relapsed after prior chemotherapy . Thirty women affected with such a relapse were included . Patients underwent extensive cytoreductive surgery including tumor resections and peritonectomy , followed by intraoperative IPCH with cisplatin . Complete surgical cytoreduction down to nodules less than 2.5 mm ( CC0—CC1 ) was obtained in 23 patients ( 77 % ) . One patient died postoperatively from a pulmonary embolism . Major postoperative morbidity was 5/30 ( 16.7 % ) . We registered one case of anastomotic leakage , a spontaneous ileum perforation , a postoperative cholecystitis , a hydrothorax , and one patient with bone marrow toxicity . Kaplan-Meier estimates of median locoregional relapse-free survival and median overall survival were 17.1 months and 28.1 months , respectively . Patients with CC0—CC1 had locoregional relapse-free and overall survival rates of 24.4 and 37.8 months , whereas the remainder had survival rates of 4.1 and 11.0 months . We concluded that cytoreductive surgery combined with IPCH is feasible with acceptable morbidity and mortality and seems to promise good results in selected patients affected with peritoneal carcinomatosis from ovarian cancer ABSTRACT Background Secondary surgical cytoreduction ( SCR ) represents a promising therapeutic strategy for patients affected by ovarian cancer disease recurrence . The aim of this prospect i ve observational trial was to analyze the role of SCR in patients with platinum-sensitive ovarian cancer . Methods Patients with platinum-sensitive ovarian cancer underwent SCR  by a single surgical team . Clinical and oncologic data were prospect ively recorded . A total of 47 patients underwent SCR from 1999 to 2003 . Results The mean operating time was 210 minutes , and mean blood loss was 500 mL. The most frequent surgical procedures carried out were splenectomy , lymphadenectomy , bowel resection , and extensive peritonectomy . Optimal cytoreduction was achieved in 41 patients . Thirty-seven patients had no visible tumor at the end of SCR . Overall median survival was 49 months . Patients who achieved optimal residual disease had a median survival of 61 months , whereas patients who had residual disease > 1 cm had a median survival of 19 months . Conclusions Positive CA-125 ( cancer antigen 125 ) was identified as a negative prognostic factor at multivariate analysis . After careful selection , optimal cytoreduction can be achieved in most patients who are subjected to SCR with acceptable morbidity . Residual tumor and CA-125 represent the most important prognostic factors OBJECTIVE The aim of this prospect i ve study was to evaluate the influence of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer . METHODS Between June 1993 and June 1999 , 149 patients after primary treatment underwent secondary cytoreductive surgery : 69 ( 46.3 % ) had recurrence-free interval ( RFI ) 7 - 12 months , 59 ( 39.6 % ) RFI 13 - 24 months , and 21 ( 14.1 % ) RFI > 24 months . Exclusion criteria included secondary cytoreduction during second-look laparotomy , interval cytoreduction , and palliative surgery in patients with intestinal obstruction or progressive disease . RESULTS The median follow-up was 27 months . According to multivariate analysis , RFI groups , prior chemotherapy combination , and residual tumor after secondary surgery were associated independently with overall survival . Resid 
    Output:
    