Neoadjuvant chemotherapy followed by interval debulking surgery versus primary debulking surgery in the advanced epithelial ovarian cancer- a retrospective cohort study

Abstract

Background / Aim. The gold standard in the treatment of an advanced ovarian cancer (AOC) is primary debulking surgery (PDS) followed by platinum-based adjuvant chemotherapy. In the AOC, an extent of tumor resection (residual tumor volume) is the most important prognostic factor for overall survival (OS) and progression-free survival (PFS). Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an experimental treatment of the AOC, introduced in a clinical practice in order to improve cytoreduction rate and prolong survival. The main objective of this study was to compare survival and cytoreduction rate of NACT+IDS and PDS. Methods. This is a retrospective cohort study that includes patients with the AOC, separated into two groups. The first group treated with PDS had 59 patients, while the second group treated with NACT+IDS had 33 patients. Results.We detected a lower rate of suboptimal cytoreduction (39.39%) in the NACT group than in the PDS group (57.63%). The percentage of complete cytoreduction was higher in patients treated with NACT (51.52%) than in those treated with PDS (38.98%). Nevertheless, median OS and PFS were not significantly different between the groups (p<0.05). OS was 35 months and 31 months in PDS and NACT group, respectively. PFS was 16 months in PDS and 19 months in the NACT group. Conclusion. In spite of the higher rate of optimal debulking surgery after NACT, survival of patients treated with NACT+IDS was not better than those treated with primary surgery. The decision for either NACT or PDS should be tailored to the individual patient. Keywords: interval debulking surgery, neoadjuvant chemotherapy, ovarian cancer, primary debulking surgery. Apstrakt. Uvod /Cilj. Zlatni standard u lečenju uznapredovalog karcinoma jajnika (AOC) je primarna citoreduktivna hirurgija (PDS) nakon koje sledi adjuvantna hemioterapija na bazi platine. Kod AOC, opseg resekcije tumora (rezidualni volumen tumora) je najvažniji prognostički faktor za ukupno preživljavanje (OS) i preživljavanje bez progresije (PFS). Neoadjuvantna hemioterapija (NACT) praćena intervalnom citoreduktivnom hirurgijom (IDS) je eksperimentalni tretman AOC, uveden u kliničku praksu kako bi se poboljšala citoredukcija i produžilo preživljavanje. Glavni cilj ovog istraživanja bio je uporediti stopu preživljavanja 4 i citoredukcije NACT + IDS i PDS. Metode. Ovo je retrospektivna kohortna studija koja uključuje pacijente sa AOC, podeljene u dve grupe. Prva grupa lečena PDS-om imala je 59 bolesnika, dok je druga grupa lečena sa NACT + IDS imala 33 bolesnika. Rezultati. Utvrdili smo nižu stopu suboptimalne citoredukcije (39,39%) u NACT grupi nego u PDS grupi (57,63%). Procenat potpune citoredukcije bio je viši kod bolesnika lečenih NACT-om (51,52%) nego kod onih lečenih PDS-om (38,98%). Ipak, srednji OS i PFS se nisu značajno razlikovali između grupa (p <0,05). OS je bio 35 meseci u PDS grupi i 31 mesec u NACT grupi. PFS je bio 16 meseci u PDS i 19 meseci u grupi pacijentkinja lečenih sa NACT-om. Zaključak. Uprkos višoj sto...