A Comparison of Survival Outcomes in Advanced Serous Ovarian Cancer Patients Treated With Primary Debulking Surgery Versus Neoadjuvant Chemotherapy

May, Taymaa; Comeau, Robyn; Sun, Ping; Kotsopoulos, Joanne; Narod, Steven A.; Rosen, Barry P.; Ghatage, Prafull

doi:10.1097/igc.0000000000000946

Cited by 49 publications

(45 citation statements)

References 29 publications

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“…To address these matters and determine the ideal treatment strategy, the ongoing Trust trial, enrolling centers guaranteeing high surgical quality and having as its primary endpoint overall survival (OS), randomized 1:1 UDS versus NACT‐IDS, patients with FIGO‐stage IIIB‐IVB tubo‐ovarian and peritoneal carcinoma. Even though surgical quality needs to be more highly standardized, studies comparing UDS versus NACT tend to overlook the need to analyze data for a specific tumor histotype or, quantify precisely the peritoneal tumor burden and evaluate in detail responses to NACT . Equally important, detailed information on the clinical history of the disease, the timing, site, treatment of recurrence, and its results could help in understanding treatment outcome in individual patients.…”

Section: Introductionmentioning

confidence: 99%

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

Biacchi

Accarpio

Ansaloni

et al. 2019

Journal of Surgical Oncology

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Background: Whether patients with advanced tubo-ovarian high-grade serous cancer (HGSC) fare better after upfront debulking surgery (UDS) or neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) remains controversial. Methods: We studied patients with HGSC who underwent UDS or NACT-IDS between July 2000 and December 2015, with peritonectomy procedures combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Clinical reports were included peritoneal cancer index (PCI), NACT responses, surgical complexity score (SCS), completeness of cytoreduction (CC), complete follow-up with timing, site, and treatment of recurrence. Outcome measures were morbidity, progression-free survival (PFS), PFS2, and overall survival during a mean 5-year follow-up. Results: A total of 34 patients (23.6%) underwent UDS and 110 (76.4%) NACT-IDS both combined with HIPEC. At a median 66.3-month follow-up, patients who underwent UDS or NACT-IDS had similar outcomes. NACT subgroup responses correlated with PCI, SCS, morbidity, and CC. Patients who underwent UDS had lower recurrence rates than those who responded partly or poorly to NACT (PFS, P < .04; PFS2, P < .01). Despite HIPEC, the peritoneal disease recurred in 42.5% of the overall patients. Conclusion: In patients with primary HGSC who undergo UDS or NACT-IDS, despite similar outcomes, peritonectomy procedures combined with HIPEC seem unable to prevent peritoneal recurrence. K E Y W O R D S HIPEC, interval debulking surgery, neoadjuvant chemotherapy, ovarian high-grade serous carcinoma, upfront debulking surgery Italian Peritoneal Surface Malignancies Oncoteam.

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Section: Introductionmentioning

confidence: 99%

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

Biacchi

Accarpio

Ansaloni

et al. 2019

Journal of Surgical Oncology

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“…In a recent comparative study of two groups, May et al (16) reported that 5-year survival was better for patients undergoing PDS than in patients who received NAC (39% vs 27%; p=0.02). However, the gross residual tm (>1 cm) ratio in the PDS group was higher in their study (28% vs 19%, p=0.02).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Survival Rates of Primary Surgery and Surgery After Neoadjuvant Chemotherapy in Ovarian Cancer

Kaban¹,

Topuz²,

Sözen³

et al. 2019

Istanbul Med J

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To compare long-term survival of primary debulking surgery (PDS) and interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) in patients with advanced ovarian cancer. Methods: Patients who underwent debulking surgery for ovarian cancer between 2001 and 2014 were included in the study. Results: Of 378 patients, 191 (50.5%) underwent PDS and 187 (49.5%) underwent IDS. Compared with PDS group, IDS was associated with higher optimal surgical performance (residual <1 cm) (83% vs 65%, p<0.001), lower visible tumor rate in the upper abdomen during surgery (12% vs 46%, p<0.001), lower intraabdominal ascites rate (2% vs 64%, p<0.001), lower postoperative (within 30 days) mortality (0 vs 5) and lower bowel resection/colostomy rate (3% vs 11%, p=0.001). The median follow-up period was 43 (1-161) months. Overall survival (OS) was longer in the PDS group [56.8 months (95% CI: 48.2-65.4) vs 43.5 (95% CI: 38.1-48.8), log-rank test p=0.026]. PDS was superior in both residual subgroups, 64.9 vs 44.6 months (p=0.008) in ≤1 cm group and 41.6 vs 25.3 months (p=0.044) in >1 cm group. The 8-year OS was higher in the PDS group (31.8% vs 12.7%). According to multivariate Cox analysis, age, suboptimal debulking, IDS and presence of tumor in the upper abdomen were independent factors associated with shorter OS duration (hazard ratio: 1.013; 1.606; 1.456 and 1.495, respectively). Conclusion: NAC in patients with FIGO 2010 stage 3 ovarian cancers is useful in reducing tumor spread, surgical morbidity and suboptimal surgery rates. However, long-term survival rates were shorter than the PDS group.

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“…También hubo una tendencia no significativa a mayor SG en las pacientes tratadas con CCR de entrada (SG a 5 años del 89 vs. 44%; p = 0.097). Por tanto, en nuestro estudio, al igual que en otros estudios publicados hasta la fecha, la CCR de entrada se asoció con mejor pronóstico en comparación con la CCR de intervalo tras quimioterapia neoadyuvante 17,18 .…”

Section: Discussionunclassified

Supervivencia tras cirugía citorreductora de máximo esfuerzo y quimioterapia basada en platino en pacientes con cáncer epitelial de ovario, carcinoma de trompa de Falopio y carcinomatosis peritoneal primaria: experiencia de un Hospital Público Universitario en España

Shahi¹,

Gutiérrez²,

Cabello³

2019

GAMO

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A Comparison of Survival Outcomes in Advanced Serous Ovarian Cancer Patients Treated With Primary Debulking Surgery Versus Neoadjuvant Chemotherapy

Abstract: Our findings suggest that among women with no residual disease, survival is better among those who undergo primary debulking surgery than treatment with neoadjuvant chemotherapy. The latter should be reserved for women who are deemed not to be candidates for primary debulking surgery.

Cited by 49 publications

References 29 publications

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

Comparison of Long-Term Survival Rates of Primary Surgery and Surgery After Neoadjuvant Chemotherapy in Ovarian Cancer

Supervivencia tras cirugía citorreductora de máximo esfuerzo y quimioterapia basada en platino en pacientes con cáncer epitelial de ovario, carcinoma de trompa de Falopio y carcinomatosis peritoneal primaria: experiencia de un Hospital Público Universitario en España

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