scholarly journals Primary Debulking Surgery for Stage III Epithelial Ovarian Cancer Has a Better Outcome Than Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery

2020 ◽  
Vol 11 (03) ◽  
pp. 142-153
Author(s):  
Anwar Tawfik Amin ◽  
Badawy M. Ahmed ◽  
Ahmed Refaat ◽  
Sileem Ahmed Sileem ◽  
Salah Mabrouk Khallaf
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Stage Iii ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery

Interval Debulking Surgery After Neodjuvant Chemotherapy Vs Primary Debulking Surgery For Stage Iii Epithelial Ovarian Carcinoma

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 15-15
Author(s):  
BM Ahmed ◽  
AT Amin ◽  
MK Khallaf ◽  
A Ahmed Refaat ◽  
SA Sileem
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Stage Iii ◽  
Debulking Surgery ◽  
Free Survival ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery ◽  
Disease Free

Introduction: Ovarian cancer is the most lethal gynecologic malignancy and is the fifth most common cause of cancer-related death among women. Approach to FIGO stage III epithelial ovarian cancer remains challengeable. This study aims to evaluate the outcome of interval debulking surgery (IDS) vs. primary debulking surgery (PDS) for FIGO stage III epithelial ovarian cancer. Materials and Methods: During a period of six years (January 2014 to December 2019), we analyzed the patients for eligibility criteria, which were: (1) FIGO stage III epithelial ovarian cancer. (2) The age of 18 years or more (3) Patients underwent either PDS or IDS and received chemotherapy at South Egypt Cancer Institute. We divided them into two groups: (1) Those received three cycles of neoadjuvant chemotherapy and then underwent IDS plus three additional cycles of adjuvant chemotherapy and (2) Those who have PDS followed by six cycles of chemotherapy. Results: This study includes 380 eligible patients. The first group included 226 patients (59.47%) underwent PDS then 6 cycles of chemotherapy, while the group of IDS included 154 patients (40.53%). The treatment modality was not significant for overall survival (OS); however disease-free survival (DFS) was significantly reduced after IDS when compared to PDS (median DFS: 33 months; 95% CI 30.23-35.77 vs. 45 months; 95% CI 41.25-48.75 respectively; p= .000). Moreover, in subgroup analysis, OS and DFS were significantly dropped after IDS in elderly patients, patients with bad performance status, sub-optimal cytoreduction as well as high grade and undifferentiated tumors when compared to those who underwent PDS. Conclusion: Although treatment modality may not impact overall survival (OS), however, PDS results in a better disease-free survival than IDS. Moreover, IDS results in a significant drop in OS and DFS in special patients subgroups when compared to PDS. Therefore patients selection should be considered.

Patterns of Recurrence and Clinical Outcome of Patients With Stage IIIC to Stage IV Epithelial Ovarian Cancer in Complete Response After Primary Debulking Surgery Plus Chemotherapy or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery: An Italian Multicenter Retrospective Study

2016 ◽  
Vol 27 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Angiolo Gadducci ◽  
Stefania Cosio ◽  
Valentina Zizioli ◽  
Sara Notaro ◽  
Roberta Tana ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Retrospective Study ◽  
Neoadjuvant Chemotherapy ◽  
Clinical Outcome ◽  
Epithelial Ovarian Cancer ◽  
Recurrence Rate ◽  
Complete Response ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery

ObjectiveThe objective of this retrospective study was to assess the clinical outcome of patients with advanced epithelial ovarian cancer in complete response after primary debulking surgery (PDS) or neoadjuvant chemotherapy followed by interval debulking surgery (IDS]).MethodsThe authors reviewed the hospital records of 384 patients who underwent PDS (n = 322) or IDS (n = 62) and who were in complete response after primary treatment.ResultsOptimal (residual disease [RD] < 1 cm) and complete (no gross RD) cytoreduction rates were higher after IDS than after PDS (71.0% vs 55.9%;P= 0.001 and 51.6% vs 35.7%, respectively;P= 0.02). Tumor recurred in 73.0% of the 322 complete responders after PDS versus 87.1% of the 62 complete responders after IDS (P= 0.01). The IDS group showed a higher recurrence rate within 6 months (11.3% vs 3.1%:P= 0.01) and a trend to higher recurrence rate between 6 and 12 months (30.6% vs 19.9%). Tumor recurred in 57.4% of the 115 completely cytoreduced patients after PDS versus 87.5% of the 32 completely cytoreduced patients after IDS (P= 0.001). The IDS group showed a trend to higher recurrence rate within 6 months (6.2% vs 1.7%) and a higher recurrence rate between 6 and 12 months (37.5% vs 15.6%;P= 0.01). Two-year, 5-year, and 7-year progression-free survival were 65.8%, 40.8%, and 39.3% for completely cytoreduced patients after PDS versus 43.8%, 12.5%, and 12.5% for completely cytoreduced patients after IDS (P= 0.001); and 2-year, 5-year, and 7-year overall survival were 96.4%, 69.3%, and 50.4% for the former versus 87.1%, 41.8%, and 32.6% for the latter (P= 0.001).ConclusionsThe clinical outcome of completely cytoreduced patients was significantly better for PDS group than for IDS group, and therefore, the achievement of no gross RD after surgery seemed to have a different prognostic relevance for the 2 groups.

scholarly journals Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Yan Gao ◽  
Yuan Li ◽  
Chunyu Zhang ◽  
Jinsong Han ◽  
Huamao Liang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Survival Curve ◽  
Progression Free Survival ◽  
Debulking Surgery ◽  
Stage Iiic ◽  
Free Survival ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery

Abstract Objective To compare the chemoresistance and survival in patients with stage IIIC or IV epithelial ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS). The clinical characteristics of patients who benefited from NACT were further evaluated. Methods We retrospectively analyzed 220 patients who underwent NACT followed by IDS or PDS from January 2002 to December 2016. Differences in clinicopathological features, chemoresistance and prognosis were analyzed. Results The incidence rate for optimal cytoreduction and chemoresistance in the NACT group was relatively higher than PDS group. No differences were observed in progression free survival or overall survival. Patients without macroscopic RD in NACT group (NACT-R0) had a similar prognosis compared to those in PDS group who had RD<1 cm, and a relatively better prognosis compared to the PDS group that had RD ≥ 1 cm. The survival curve showed that patients in NACT-R0 group that were chemosensitive seemed to have a better prognosis compared to patients in PDS group that had RD. Conclusion Patients without RD after PDS had the best prognosis, whereas patients with RD after NACT followed by IDS had the worst. However, even if patients achieved no RD, their prognosis varied depending on chemosensitivity. Survival was better in patients who were chemosensitive compared to thosewho underwent PDS but had RD. Hence evaluating the chemosensitivity and feasibility of complete cytoreduction in advance is crucial.

scholarly journals Clinical significance of primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery in advanced ovarian cancer

2020 ◽  
Vol 50 (4) ◽  
pp. 379-386
Author(s):  
Shin Nishio ◽  
Kimio Ushijima
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Clinical Significance ◽  
Performance Status ◽  
Advanced Ovarian Cancer ◽  
Stage Iii ◽  
Current Evidence ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery

Abstract Primary debulking surgery followed by platinum-based chemotherapy remains the standard treatment of patients with stage III–IV epithelial ovarian cancer. Neoadjuvant chemotherapy is an alternative treatment regimen that can be considered in selected patients. Complete cytoreduction, both through primary debulking surgery and interval debulking surgery, has a major positive effect on survival and should be the goal, even if this requires extensive surgery. When thorough assessment of tumor spread and performance status of the patient indicates that complete primary cytoreduction is not feasible without unacceptable morbidity, then alternative therapeutic strategies, such as neoadjuvant chemotherapy, must be considered. Such patients can be offered the option of interval debulking surgery after checking their response to neoadjuvant chemotherapy and resolution of the initial obstacles for primary debulking surgery (i.e. complete response of irresectable disease and improvement of the performance status). Current evidence suggests that a selected group of patients with International Federation of Gynecology and Obstetrics stage III–IV ovarian cancer will benefit from NAC-IDS. Research is ongoing to identify patients who might derive the greatest benefit from neoadjuvant chemotherapy followed by interval debulking surgery, instead of primary debulking surgery, on the basis of radiological, genetic, pathological, and immunological variables. In this review, we discuss current knowledge about the clinical significance of primary debulking surgery and neoadjuvant chemotherapy in advanced ovarian cancer and discuss unanswered questions in the field.

scholarly journals Neoadjuvant chemotherapy in epithelial ovarian cancer: Largest single institute experience

2016 ◽  
Author(s):  
Siva Kumar
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Advanced Disease ◽  
Optimal Cytoreduction ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery ◽  
Disease Free

Purpose: Neoadjuvant chemotherapy followed by interval debulking surgery (IDS) is an alternative treatment option, compared to the current standard of care primary debulking surgery for treating advanced epithelial ovarian cancer (EOC). We present our institute experience of neoadjuvant chemotherapy strategy in the management of EOC which is one of the largest single institute experience. Methods: This is a retrospective analysis of patients with epithelial ovarian cancer who were treated in our institute between 2000 and 2006. Patient with advanced disease by clinical and imaging were treated with 3 cycles ofneoadjuvant chemotherapy and then taken up for interval debulking surgery (IDS) who had static or partial or complete response to chemotherapy. The remaining chemotherapy is delivered after the surgery. Patient who had limited disease had primary debulking surgery and then adjuvant chemotherapy according to institute protocol. Outcomes in terms of disease free and overall survival were analysed. Results: This retrospective analysis included 59 patients with limited disease who had primary debulking surgeryand 283 patients with advanced disease who recievedneoadjuvant chemotherapy. The median age was 50 years and majority are in the 50-59 years age group. Age more than 60 years represent 14.5%. Postmenopausal women were 55.3% and premenopausal women were 44.7 %. Multiparity is higher 70.2% than the uniparity 16.4% ornulliparity 11.7%. Abdomen distension 42% and pain 25% are the most common symptoms. Advanced stage was the most common presentation 71% with stage III-56.1% and stage IV-14.9%. Among the neoadjuvant chemotherapy group 126/283 (44.5%) had optimal cytoreduction, 44/283 (15.5%) had suboptimal cytoreduction and 113/283 (40%) not suitable for IDS. The 5 year disease free and overall survival was 30.8% and 41.5% in the NACT group with advanced disease and 58.5% and 75.8% in the primary cytoreduction group who had limited diseaserespectively. The 5 years overall survival among the IDS group with optimal cytoreduction was 57.1% and 11.7% for the suboptimal cytoreduction group. The 5 years survival was not affected by the number ofneoadjuvant chemotherapycycles delivered before surgery in the IDS group. Patient who received paclitaxol + carboplatin as first line chemotherapy had better survival than carboplatin alone or cyclophosphamide + cisplatin. Conclusion: NACT as an alternative option to primary debulking surgery in operable EOC is still debatable. But for patient with high disease burden where optimal cytoreduction is not possible NACT strategy is a valid option. Recent randomised controlled trials from Europe had shown the noninferiority of neoadjuvant chemotherapy followed by IDS when compared to the primary debulking surgery in operable advanced EOC.

scholarly journals Neoadjuvant chemotherapy in epithelial ovarian cancer: Largest single institute experience

2016 ◽  
Author(s):  
Siva Kumar
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Advanced Disease ◽  
Optimal Cytoreduction ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery ◽  
Disease Free

Purpose: Neoadjuvant chemotherapy followed by interval debulking surgery (IDS) is an alternative treatment option, compared to the current standard of care primary debulking surgery for treating advanced epithelial ovarian cancer (EOC). We present our institute experience of neoadjuvant chemotherapy strategy in the management of EOC which is one of the largest single institute experience. Methods: This is a retrospective analysis of patients with epithelial ovarian cancer who were treated in our institute between 2000 and 2006. Patient with advanced disease by clinical and imaging were treated with 3 cycles of neoadjuvant chemotherapy and then taken up for interval debulking surgery (IDS) who had static or partial or complete response to chemotherapy. The remaining chemotherapy is delivered after the surgery. Patient who had limited disease had primary debulking surgery and then adjuvant chemotherapy according to institute protocol. Outcomes in terms of disease free and overall survival were analysed. Results: This retrospective analysis included 59 patients with limited disease who had primary debulking surgery and 283 patients with advanced disease who received neoadjuvant chemotherapy. The median age was 50 years and majority are in the 50-59 years age group. Age more than 60 years represent 14.5%. Postmenopausal women were55.3 % and premenopausal women were 44.7 %. Multiparity is higher 70.2% than the uniparity 16.4% ornulliparity 11.7%. Abdomen distension 42% and pain 25 % are the most common symptoms. Advanced stage was the most common presentation 71% with stage III-56.1% and stage IV-14.9%. Among the neoadjuvant chemotherapy group 126/283(44.5%) had optimal cytoreduction, 44/283 (15.5%) had suboptimal cytoreduction and 113/283 (40%) not suitable for IDS. The 5 year disease free and overall survival was 30.8% and 41.5% in the NACT group with advanced disease and 58.5% and 75.8% in the primary cytoreduction group who had limited diseaserespectively. The 5 years overall survival among the IDS group with optimal cytoreduction was 57.1% and 11.7% for the suboptimal cytoreduction group. The 5 years survival was not affected by the number of neoadjuvant chemotherapy cycles delivered before surgery in the IDS group. Patient who received paclitaxol + carboplatin as first line chemotherapy had better survival than carboplatin alone or cyclophosphamide + cisplatin. Conclusion: NACT as an alternative option to primary debulking surgery in operable EOC is still debatable. But for patient with high disease burden where optimal cytoreduction is not possible NACT strategy is a valid option. Recent randomised controlled trials from Europe had shown the noninferiority of neoadjuvant chemotherapy followed by IDS when compared to the primary debulking surgery in operable advanced EOC.

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