Interval debulking surgery: An alternative for primary surgical debulking?

Abstract

Retrospective analyses suggest that a subgroup of patients with Stage III and IV ovarian carcinoma can be treated with neo‐adjuvant chemotherapy followed by interval debulking surgery. The absolute indications for neo‐adjuvant chemotherapy appear to be Stage IV disease (excluding pleural fluid) or metastases of more than 1 g at sites where resection is impossible. In patients with an estimated total metastatic tumor load of >100 g, the presence of at least two of the following relative indications for neo‐adjuvant chemotherapy are considered to be necessary: 1) uncountable (>100) peritoneal metastases, 2) estimated metastatic tumor load of >1000 g, 3) presence of large (>10 g) peritoneal metastatic plaques, 4) large volume ascites, and 5) World Health Organization (WHO) status II or III. Interval debulking surgery in patients with suboptimal primary debulking surgery has been proven effective in increasing overall survival and progression‐free survival in a large prospective, randomized trial of the European Organization for Research and Treatment of Cancer (EORTC). The strategy of neo‐adjuvant chemotherapy, followed by interval debulking surgery, should be confirmed in a prospective randomized trial. The EORTC 55971 trial is currently addressing this issue. We will review the studies on primary chemotherapy, interval debulking surgery, and the indications for primary chemotherapy followed by interval debulking surgery, and ongoing trials. Semin. Surg. Oncol. 19:49–53, 2000. © 2000 Wiley‐Liss, Inc.

Neoadjuvant chemotherapy followed by tumor debulking prolongs survival for patients with poor prognosis in International Federation of Gynecology and Obstetrics Stage IIIC ovarian carcinoma

“…The lack of evidence to date of the superiority of neoadjuvant chemotherapy compared with conventional therapy could be because of an inadequate patient selection in these studies. In studies by Schwartz et al and Vergote et al, all patients with advanced ovarian carcinoma received neoadjuvant chemotherapy, including those patients whose tumors could have been resected free of macroscopic residual tumor and who thus would have had good median survival11, 19 regardless. For these patients, additional improvement of these already relatively favorable therapy results due to neoadjuvant chemotherapy was not very likely, so that any possible advantage of neoadjuvant chemotherapy becomes very difficult to prove within the group of patients with potentially completely resectable tumors.…”

A rare case of ovarian cancer in pregnancy complicated by pulmonary embolus and myocardial infarction: management dilemmas

“…This is partly dependent on surgical experience. In fact, trials have shown that the rates of optimal PDS in small centres are around 20–30% compared with 60–90% in highly specialized gynaecological oncology centres [ 9 ]. Patient characteristics also influence resectability of widespread disease [ 10 ].…”

Os benefícios da ressecção anterior baixa em monobloco para o câncer de ovário avançado: dez anos de experiência em um único centro terciário

“…Resultados similares foram observados por Mohamed et al 11 sinalizando que a citorredução de intervalo após quimioterapia neo-adjuvante, deva ser realizada quando existe a possibilidade de um procedimento alargado com múltiplas ressecções e anastomoses para se atingir uma citorredução ótima. As complicações maiores dessa série como abscessos intra-cavitários devido às fístulas tanto de anastomose colorretal quanto de intestino delgado, também têm sido descritas por outros autores quando se trata de citorredução ótima com ressecções multiviscerais.…”

“…10 Como alternativa estratégica, com o objetivo de se evitar cirurgias multiviscerais, a utilização da quimioterapia neoadjuvante tem sido recomendada em associação a citorredução de intervalo. [11][12] Embora existam poucas séries descritas na literatura sobre o uso dessa operação no tratamento do câncer de ovário, especificamente no Brasil não encontramos nenhuma.…”