Neoadjuvant chemotherapy, interval debulking surgery or primary surgery in ovarian carcinoma FIGO stage IV?

2012 ◽  
Vol 48 (14) ◽  
pp. 2146-2154 ◽  
Author(s):  
Claes G. Tropé ◽  
Mari B. Elstrand ◽  
Berit Sandstad ◽  
Ben Davidson ◽  
Halldis Oksefjell
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Ovarian Carcinoma ◽  
Stage Iv ◽  
Figo Stage ◽  
Debulking Surgery ◽  
Primary Surgery ◽  
Interval Debulking Surgery

scholarly journals Predictive value of changes in the serum CA-125 levels in patients undergoing interval debulking surgery after neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

2019 ◽  
Vol 8 (2) ◽  
pp. 483
Author(s):  
Sonia Batra ◽  
Ruchi Arora ◽  
Kalpana Dave
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Ovarian Carcinoma ◽  
Predictive Value ◽  
Epithelial Ovarian Carcinoma ◽  
Ca 125 ◽  
Optimal Cytoreduction ◽  
Normal Range ◽  
Debulking Surgery ◽  
Ovarian Cancers ◽  
Interval Debulking Surgery

Background: The objective of this study is to evaluate the predictive value of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in advanced epithelial ovarian carcinoma (EOC).Methods: A retrospective hospital-based study of patients with advanced epithelial ovarian cancers (stage III and IV) was conducted at Department of Obstetrics and Gynecology in Gujarat Cancer and Research Institute, Ahmedabad, for two years. Total 50 patients were treated with NACT followed by surgical cytoreduction and followed up till August 2010. Response to NACT, optimal cytoreduction rate and overall response rate were analyzed.CA 125 levels before (baseline) and after NACT were analyzed.Results: Out of 50, there were 43 patients (86%) with stage III disease and 7 (14%) with stage IV disease. Maximum 37(74%) patients had CA 125 levels >500 on presentation while none of the patients had baseline CA125 levels in the normal range (<35). Range of baseline CA 125 was 164-5394.All patients were given NACT and after NACT, out of 50 patients, 22(44%) patients had CA 125 values within the normal range (<35) while 23(46%) had values between 35 and 100. Thus, statistically significant difference (Z = 6.154, P<0.0001) was found between CA 125 level before and after NACT. Out of 45 patients with CA 125 <100, 35(77.8%) underwent optimal cytoreduction.Conclusions: Baseline (prechemotherapy) serum CA-125 levels are powerful indicators of the presence and extent of spread of disease while CA-125 level particularly <100U/ml after NACT strongly predicts optimal cytoreduction in advanced epithelial ovarian cancers.

A population registry trend analysis of neoadjuvant chemotherapy and incidence of ovarian, peritoneal and fallopian tube carcinomas in England 2004-2015.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17037-e17037
Author(s):  
Rebecca Elleray ◽  
Cong Chen ◽  
Sean Kehoe
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Fallopian Tube ◽  
Stage Iv ◽  
Figo Stage ◽  
Stage Iii ◽  
Disease Stage ◽  
Primary Therapy ◽  
Peritoneal Cancer ◽  
Primary Surgery

e17037 Background: Two important developments in ovarian cancer have occurred over the last decade: i) EORTC 55971 and CHORUS trials reporting neoadjuvant chemotherapy as a management strategy in advanced disease and ii) recognition of fallopian tubes as the origin of many ovarian cancers. This study examines how these have impacted on care and registry data. Methods: The National Cancer Registry and Analysis Service (NCRAS) database identified women registered with ovarian, peritoneal and fallopian tube carcinomas during 2004-15. Treatment was defined as surgical intervention or chemotherapy starting within 6 months of diagnosis. Women were grouped into: Neoadjuvant chemotherapy, Primary surgery, Chemotherapy only, Surgery only or No record of therapy. Groups were analysed by year, FIGO stage and age. Results: 66,768 women were registered with an invasive carcinoma. Disease stage was not recorded in 44%. Of the remaining (n = 36,779) 32.1% stage I/II and 67.9% had stage III/IV disease. Of the 66,768 cases, 12.5 % had Neoadjuvant chemotherapy, 28.7% Primary surgery, 15.2% Surgery only, 19.7% Chemotherapy only and 23.2% No recorded therapy. Chemotherapy only was commonest at 36% in Stage IV, whereas primary surgery was in Stage III disease at 38%. No therapy was recorded in 11% and 25% of stage III and IV disease respectively. Neoadjuvant chemotherapy use trebled with time: comparing the rate in 2004-6 to 2013-15, there was an increase from7.7% to 21.7% ( p< 0.001). Those diagnosed with primary peritoneal cancer were significantly more likely ( p< 0.001) to have neoadjuvant chemotherapy compared to other groups. Cancers of the primary peritoneal and fallopian tube make up an increasing proportion of cases from 6% in 2004 to 13% in 2015. Conclusions: This is the largest reported study assessing trends in primary therapy and cases of ovarian, peritoneal and fallopian tube cancers during a time of novel developments. Neoadjuvant chemotherapy is becoming embedded in clinical practice. The reporting and analysis of ovarian cancer should include peritoneal and fallopian tube for consistent categorisation.

scholarly journals Pathologic distribution at the time of interval tumor reductive surgery informs personalized surgery for high-grade ovarian cancer

2020 ◽  
pp. ijgc-2020-001597
Author(s):  
Courtney D Bailey ◽  
Rebecca Previs ◽  
Bryan M Fellman ◽  
Tarrik Zaid ◽  
Marilyn Huang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Large Bowel ◽  
Primary Tumor ◽  
High Grade ◽  
Debulking Surgery ◽  
Primary Surgery ◽  
Surgery Group ◽  
Interval Debulking Surgery ◽  
Interval Surgery

IntroductionThe surgical approach for interval debulking surgery after neoadjuvant chemotherapy has been extrapolated from primary tumor reductive surgery for high-grade ovarian cancer. The study objective was to compare pathologic distribution of malignancy at interval debulking surgery versus primary tumor reductive surgery.MethodsPatients with a diagnosis of high-grade serous or mixed, non-mucinous, epithelial ovarian, fallopian tube or primary peritoneal cancer who underwent neoadjuvant chemotherapy or primary tumor reductive surgery and had at least 6 months of follow-up were identified through tumor registry at a single institution from January 1995 to April 2016. Pathologic involvement of organs was categorized as macroscopic, microscopic, or no tumor. Statistical analyses included Mann-Whitney and Fisher’s exact tests.ResultsOf 918 patients identified, 366 (39.9%) patients underwent interval debulking surgery and 552 (60.1%) patients underwent primary tumor reductive surgery. Median age was 62.3 years (range 25.3–92.5). The majority of patients in the interval debulking surgery group were unstaged (261, 71.5%). In the patients who had a primary tumor reductive surgery, 406 (74.6%) had stage III disease. In both groups, the majority of patients had serous histology: 325 (90%) and 435 (78.8%) in the interval debulking and primary tumor reductive surgery groups, respectively. There was a statistically significant difference between disease distribution on the uterus between the groups; 31.4% of the patients undergoing interval debulking surgery had no evidence of uterine disease compared with 22.1% of primary tumor reductive surgery specimens (p<0.001). In the adnexa, there was macroscopic disease present in 253 (69.2%) and 482 (87.4%) of cases in the interval vs primary surgery groups, respectively (p<0.001). Within the omentum, no tumor was present in the omentum in 52 (14.2%) in the interval surgery group versus 91 (16.5%) in the primary surgery group (p<0.001). In the interval surgery group, there was no tumor involving the small and large bowel in 49 (13.4%) and 28 (7.7%) pathologic specimens, respectively. This was statistically significantly different from the small and large bowel in the primary surgery group, of which there was no tumor in 20 (3.6%, p<0.001) and 16 (2.9%, p<0.001) of cases, respectively.ConclusionIn patients undergoing interval debulking surgery, there was less macroscopic involvement of tumor in the uterus, adnexa and bowel compared with patients undergoing primary cytoreductive surgery.

Is there a role for neoadjuvant chemotherapy in the treatment of stage IV serous endometrial carcinoma?

2006 ◽  
Vol 16 (Suppl 1) ◽  
pp. 273-277 ◽  
Author(s):  
E. Despierre ◽  
P. Moerman ◽  
I. Vergote ◽  
F. Amant
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Endometrial Carcinoma ◽  
Clinical Course ◽  
Residual Disease ◽  
Stage Iv ◽  
Residual Tumor ◽  
Lymphatic Spread ◽  
Debulking Surgery ◽  
Interval Debulking Surgery ◽  
Aggressive Clinical Course

Serous endometrial carcinoma (SEC) is an uncommon variant of endometrial carcinoma that is notorious for its aggressive clinical course. Similar to its ovarian counterpart, it has a propensity for early intraabdominal and lymphatic spread. We present two cases of advanced SEC, who were left with no residual tumor after neoadjuvant chemotherapy. After three courses of chemotherapy, both patients underwent interval debulking surgery, resulting in no residual disease. The documentation of chemosensitivity might enable the clinician to select a subpopulation of patients with widespread SEC that might benefit from interval debulking surgery.

Timing of debulking surgery in advanced ovarian cancer

2008 ◽  
Vol 18 (Suppl 1) ◽  
pp. 11-19 ◽  
Author(s):  
I. Vergote ◽  
T. Van Gorp ◽  
F. Amant ◽  
K. Leunen ◽  
P. Neven ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Ovarian Cancer ◽  
Residual Tumor ◽  
Figo Stage ◽  
Debulking Surgery ◽  
European Organization ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery ◽  
Tumor Load

It is clear that primary debulking remains the standard of care within the treatment of advanced ovarian cancer (FIGO stage III and IV). This debulking surgery should be performed by a gynecological oncologist without any residual tumor load, or so-called “optimal debulking.” Over the last decades, interest in the use of neoadjuvant chemotherapy together with an interval debulking has increased. Neoadjuvant therapy can be used for patients who are primarily suboptimally debulked due to an extensive tumor load. In this situation, based on the randomized European Organization for Research and Treatment of Cancer–Gynaecological Cancer Group trial, interval debulking by an experienced surgeon improves survival in some patients who did not undergo optimal primary debulking surgery. Based on the GOG 152 data, interval debulking surgery does not seem to be indicated in patients who underwent primarily a maximal surgical effort by a gynecological oncologist. Neoadjuvant chemotherapy can also be used as an alternative to primary debulking. In retrospective analyses, neoadjuvant chemotherapy followed by interval debulking surgery does not seem to worsen prognosis compared to primary debulking surgery followed by chemotherapy. However, we will have to wait for the results of future randomized trials to know whether neoadjuvant chemotherapy followed by interval debulking surgery is a good alternative to primary debulking surgery in stage IIIc and IV patients. Open laparoscopy is probably the most valuable tool for evaluating the operability primarily or at the time of interval debulking surgery

Sign in / Sign up

Export Citation Format

Share Document