An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT)

Advanced Ovarian Cancer: Primary or Interval Debulking? Five Categories of Patients in View of the Results of Randomized Trials and Tumor Biology: Primary Debulking Surgery and Interval Debulking Surgery for Advanced Ovarian Cancer

“…The median operation time (both arms) was even shorter in the CHORUS trial (120 minutes) [9].This might suggest suboptimal efforts at PDS, supported by the fact that only 40% of patients were left with tumor #1 cm after PDS in both trials. This rate is much lower than in the single-institutions studies (GOG and Arbeitsgemeinschaft Gynaekologische Onkologie [AGO] studies [25][26][27][28][29]). …”

“…Single-institution trials showing that complete debulking to no macroscopic RD (0 cm) implied the best prognosis [25][26][27][28][29] and led to even more aggressive PDS. A retrospective review of six Gynecologic Oncology Group (GOG) studies (n 5 1,895; FIGO stage III; PDS plus six cycles of carboplatinum-taxol) [27] showed that for patients with RD #1 cm, those left with no RD obtained the best prognosis.…”

“…Chi et al [25] used identical inclusion criteria and treated 285 patients with PDS during the same period. They achieved cytoreduction to #1 cm in 71%, resulting in a PFS of 17 months and OS of 50 months compared with 41%, 17 months, and 29 months, respectively, for the PDS arm in the EORTC/NCIC study.…”

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

“…[13,14,25,26,[51][52][53][54][55][56][57]. Thus, most of the results obtained with the addition of HIPEC to standard frontline therapy seem to be similar or inferior to the results obtained without the use of HIPEC.…”

The optimal time for surgery in women with serous ovarian cancer

“…[29][30][31] Importantly, several studies addressing the use of primary surgery versus neoadjuvant chemotherapy indicated that patients in the NAC group have inferior overall survival than patients in the PCS group. [32][33][34] Bristow and Chi 16 conducted a meta-analysis that suggested the number of neoadjuvant chemotherapy cycles before surgery was inversely proportional to the median overall survival. In addition, these authors demonstrated that although the difference in survival between the NAC and PCS groups did not reach statistical significance in previous studies, survival was often reduced by up to half in the NAC group.…”