Does the Number of Neoadjuvant Chemotherapy Cycles before Interval Debulking Surgery Influence Survival in Advanced Ovarian Cancer?

Abstract

Objective: To evaluate the overall survival (OS) of patients with initially inoperable advanced ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma of stages III or IV undergoing neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery, according to the number of cycles performed. Methods: This retrospective study was conducted in three main oncology centres in the east of France, reviewing the charts of all patients who underwent NAC between January 1, 1998 and October 31, 2012. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analysed progression-free survival (PFS) as well as chemotherapy- and surgery-related morbidity. Results: Of the 204 patients included, 75 (36.8%) underwent ≤4 NAC cycles and 129 (63.2%) ≥5 NAC cycles. Characteristic data were similar in the two groups. Five-year OS was 35.0 and 25.8%, respectively. This difference was non-significant [HR = 1.06 (0.70-1.59), p = 0.79]. We also found no differences in PFS or morbidity between the two groups. Conclusions: The number of NAC cycles does not seem to play a role in the OS of patients with advanced ovarian cancer. Further evidence and prospective data are needed to assess the value of a high/low number of NAC cycles among these patients.

Prognostic role of pathologic response and cytoreductive status at interval debulking surgery after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

“…The value of defining the prognostic role of pathologic response from IDS after NACT is that this information has the potential to guide therapy. For example, given the lack of data on the ideal number of adjuvant cycles of chemotherapy following IDS, pathologic response could be explored as a means to triage patients to less or more adjuvant chemotherapy cycles after IDS . Pathologic response could also be explored as a prognostic marker to help refine a population that might benefit from treatment strategies beyond platinum doublets in the upfront setting, such as maintenance bevacizumab.…”

Impact of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy cycles on survival of patients with advanced-stage ovarian cancer

“…The protocols of these two trials specified that IDS should be performed after 3 cycles of NAC. Other recent studies have reported conflicting results for performing late IDS after >4 cycles of NAC in patients with advanced ovarian cancer [ 12 – 16 ]. In one previous study, IDS after >6 cycles of NAC was found to be both safe and effective, with outcomes equivalent to those reported for the standard treatment [ 13 ].…”

“…In one previous study, IDS after >6 cycles of NAC was found to be both safe and effective, with outcomes equivalent to those reported for the standard treatment [ 13 ]. Akladios et al reported that the number of NAC cycles did not affect the survival of advanced-stage ovarian cancer patients [ 12 ], while Colombo et al reported that patients who received >4 cycles of NAC before IDS experienced poor prognosis, despite optimal debulking surgery. Similarly, Xu et al reported that patients who underwent >5 cycles of NAC experienced shorter PFS than patients who underwent <5 cycles [ 16 ].…”

“…However, the optimal number of chemotherapy cycles before and after IDS has not been prospectively evaluated, and various clinical regimens are currently utilized based on the patient condition and physician preference. Several studies have demonstrated the safety and feasibility of late IDS, defined as IDS performed after more than 4 cycles of NAC [ 12 – 14 ], whereas others have reported poorer outcomes in patients undergoing late IDS [ 15 , 16 ]. Furthermore, there is currently no evidence that additional chemotherapy of more than 6 cycles of first-line chemotherapy improves outcomes in patients with advanced-stage ovarian cancer [ 17 ].…”

Liver Metastasis: Update on Thermal and Nonthermal Ablative Therapies

“…Management of recurrent disease, including liver metastases, included repeat surgery. 58,59 Limited literature exists regarding the use of ablative therapies to treat liver metastatic disease. Gervais et al reported a high technical success in series of six patients with metastatic ovarian carcinoma to the liver treated with RFA with absent local progression for a mean of 2.5 years.…”