Neoadjuvant Chemotherapy for Advanced Ovarian Cancer: Long-Term Survival

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

“…Debulking after the receipt of neoadjuvant chemotherapy appears to be associated with less operative morbidity and improved rates of optimal cytoreduction. 6,[11][12][13][14][15] Chambers et al 11 in 1990 and Schwartz et al 13 in 1994 compared the outcomes of patients with clinical evidence of advanced-stage ovarian carcinoma treated with neoadjuvant chemotherapy with patients with suboptimally debulked Stage IIIC and Stage IV ovarian carcinoma who were later treated with chemotherapy. They found that the overall survival was the same for both groups of patients but that the patients who received neoadjuvant treatment better tolerated chemotherapy.…”

“…They found that the overall survival was the same for both groups of patients but that the patients who received neoadjuvant treatment better tolerated chemotherapy. In addition, in 1999, Schwartz et al 14 demonstrated that women who underwent cytoreductive surgery after induction chemotherapy had statistically improved overall survival compared with women who did not undergo surgery. These data suggest a need to prospectively identify patients who are most likely to undergo suboptimal surgery and who may be more appropriately treated with neoadjuvant therapy.…”

The optimal time for surgery in women with serous ovarian cancer

“…Other retrospective analyses have reported similar findings. [18][19][20][21][22][23][24][25][26][27][28] By contrast, several studies have shown that patients treated with neoadjuvant chemotherapy have a worse survival than those treated with primary surgery. [32][33][34] Overall, controversy remains about the use of neoadjuvant chemotherapy as a first-line treatment strategy for women with newly diagnosed HGSC.…”

“…17 Many studies suggest equivalent survival in patients receiving adjuvant versus neoadjuvant chemotherapy. [18][19][20][21][22][23][24][25][26][27][28] Notably, Vergote and colleagues 20 reported the only phase III randomized controlled trial in which patients with advanced-stage HGSC were treated with either primary surgery and adjuvant platinum-based chemotherapy (PCS group) or neoadjuvant platinum-based chemotherapy followed by interval cytoreductive surgery and additional adjuvant chemotherapy (NAC group). Although patients in the NAC group had higher rates of optimal cytoreduction and fewer perioperative complications, this did not translate into improved survival.…”

Socioeconomic factors may contribute to neoadjuvant chemotherapy use in metastatic epithelial ovarian carcinoma

“…However because NCT may negatively impact survival, it is still considered a less optimal treatment option. The rationale behind the use of NCT is that patients will tolerate chemotherapy better if given prior to aggressive surgery and that pre-operative chemotherapy will reduce tumor volume thus facilitating optimal debulking and resulting shorter operative times and hospital stays [4][5][6]. This may be especially useful in patients with multiple comorbidities that preclude immediate aggressive cytoreductive surgery.…”