Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center

Abstract

Objective The aim of this study was to evaluate the use of neoadjuvant chemotherapy (NACT) and primary debulking surgery (PDS) before and after results from a randomized trial were published and showed non-inferiority between NACT and PDS in the management of advanced-stage ovarian carcinoma. Methods We evaluated consecutive patients with advanced-stage ovarian cancer treated at our institution from 1/1/08–5/1/13, which encompassed 32 months before and 32 months after the randomized trial results were published. We included all newly diagnosed patients with high-grade histology and stage III/IV disease. Associations between the use of NACT and clinical variables over time were evaluated. Results Our study included 586 patients. Median age was 62 years (range, 30–90); 406 patients (69%) had stage III disease, and 570 (97%) had disease of serous histology. Twenty-six percent (154/586) were treated with NACT and 74% (432/586) with PDS. NACT use increased significantly from 22% (56/256) before 2010 (at which point the results of the randomized trial were published) to 30% (98/330) after 2010 (p = 0.037). Although patients who underwent PDS were more likely to experience grade 3/4 surgical complications than those who underwent NACT, those selected for PDS had a median OS of 71.7 months (CI, 59.8-not reached) compared with 42.9 months (CI 37.1-56.3) for those selected for NACT. Conclusions In this single-institution analysis, the best survival outcomes were observed in patients who were deemed eligible for PDS followed by platinum-based chemotherapy. Selection criteria for NACT require further definition and should take institutional surgical strategy into account.

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

“…There has been an increase in use of neoadjuvant chemotherapy in North America over the last few years. 5,22,24 This trend is likely the consequence of 2 recent randomized controlled trials reporting equivalent survival rates among women with advanced ovarian carcinoma that were treated with neoadjuvant chemotherapy or primary debulking surgery. 11,12 The results from the current study question this position.…”

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

“…Originally, NAC followed by an IDS was limited to patients who were poor surgical candidates or unlikely to be resected optimally [7, 9-12, 14-22, 25-29, 31-40]. However, the EORTC/NCIC trial showed the similar median OS (30.0 vs. 29.0 months) and median PFS (12 vs. 12 months) between the NAC group and PDS group, concluding that NAC followed by IDS was a reasonable treatment for advanced ovarian carcinoma.…”

1st Evidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer

“…The role of first-line surgery in advanced OC is upheld by international guidelines (61, 62) on the basis of data from existing studies, which are mainly retrospective, and from single series of prospective studies, as well as systematic reviews (63)(64)(65)(66)(67)(68)(69)(70). It should be carried out by an oncologic gynecologist (71).…”