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

Abstract

BACKGROUND Patients with advanced ovarian carcinoma of International Federation of Gynecology and Obstetrics (FIGO) Stage IIIC should be treated by radical surgical tumor debulking with the goal of complete tumor resection. Prolonged median survival can be achieved in those patients entirely free of tumor after surgery by the administration of postsurgical platinum/taxane‐based chemotherapy regimens. However, residual tumor is present in the majority of patients, which limits survival prognosis. Different therapy approaches should be utilized to improve prognosis in these patients. Neoadjuvant chemotherapy could induce “downstaging” of the tumor and thus improve operability. Here, evidence of large ascites volume (>500 mL) can be used to identify those patients who could benefit from neoadjuvant chemotherapy. METHODS In a prospective, nonrandomized Phase II study, 31 patients with advanced FIGO Stage IIIC ovarian carcinoma and large ascites volume (>500 mL) received 3 cycles of platinum/taxane‐based combination chemotherapy, followed by tumor debulking surgery and 3 additional cycles of platinum/taxane‐based combination chemotherapy. During the same period, 32 patients with advanced FIGO Stage IIIC ovarian carcinoma and large ascites volume (>500 mL) received conventional therapy (tumor debulking surgery followed by 6 cycles of platinum/taxane‐based combination chemotherapy). The two groups were investigated and compared with respect to tumor resection rates, blood transfusion requirements, morbidity, and mortality during surgery, duration of surgery, and median survival. RESULTS The tumor resection rate in the patient group receiving neoadjuvant chemotherapy was significantly higher (P = 0.04) than that of the conventionally treated group; the median survival time of 42 months versus 23 months also was significantly longer (P = 0.007). Time spent in surgery, blood transfusion requirements, morbidity, and mortality during surgery were not significantly different. CONCLUSIONS Patients with advanced ovarian carcinoma of FIGO Stage IIIC who will benefit only marginally from conventional therapy can be identified by evidence of large ascites volume. Higher tumor resection rates and longer median survival can be achieved in these patients by the use of neoadjuvant chemotherapy. A prospective randomized multicenter study currently is being performed by the Society for Gynecological Oncology in Germany to confirm these findings. Cancer 2001;92:2585–91. © 2001 American Cancer Society.

Comparison of Platinum-based Neoadjuvant Chemotherapy and Primary Debulking Surgery in Patients with Advanced Ovarian Cancer

“…Similar to our findings, Giannopoulos and colleagues [16] found lower mean blood loss in NAC group. Unlike our findings, Kuhn et al [25] and Yan and colleagues [26] found no difference in need for transfusion and intraoperative bleeding.…”

Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer

“…Neoadjuvant chemotherapy decreases tumor volume and facilitates surgical procedures especially chemosensitive tumor which had completed or partial clinical response achievement in 76% of patients with less residual volume which had an impact of decrease morbidity and mortality and improving clinical outcome [16]- [23]. Analysis of our data showed significant improvement in both progression-free survival and overall survival in those underwent NACT-IDS compared to PDS-ACTR these results comparable to those published by Kuhn et al [24] [25], Rose et al, and Muggia et al [6] [24] [25] [26], they showed prolonged survival times and significantly better median survival in NACT group than the conventional PDS-ACTR. According to data published by Onnis et al [18] and Surwit et al…”

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

“…Other studies also reported that patients who underwent NAC/IDS had lower estimated blood loss and shorter OR time and hospital stay (12,14,20). Only a few studies found no difference in perioperative morbidity between the NAC/ IDS and PDS groups (4).…”

“…The effect of NAC/IDS on survival and perioperative morbidity varies in these studies (4)(5)(6). According to these studies, patients treated with NAC/IDS had comparable survival with those who underwent PDS (5,(7)(8)(9).…”

“…The majority of the studies showed that NAC/IDS had no impact on OS compared with PDS, including a meta-analysis of 21 studies and a recently published randomized trial (5,8,9,13,14,16). NAC/IDS was found to improve survival (4,12,17). However, a metaanalysis pointed out that NAC/IDS survival outcomes were inferior compared with conventional primary surgery (18).…”