Neoadjuvant chemotherapy for unresectable ovarian carcinoma

Ansquer, Yan; Leblanc, Éric; Clough, Krichna; Morice, Philippe; Dauplat, J.; Mathevet, Patrice; Lhommé, C.; Scherer, Christophe; Tigaud, J; Benchaïb, Mehdi; Fourme, Emmanuelle; Castaigne, D.; Querleu, Denis; Dargent, D

doi:10.1002/1097-0142(20010615)91:12<2329::aid-cncr1265>3.3.co;2-l

Cited by 34 publications

(58 citation statements)

References 6 publications

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“…Hence NACT may be helpful in achieving cytoreduction and converting possible suboptimal initial surgery into optimal surgery. Several studies [8,9,[11][12][13][14][15] have established the role of platinum based NACT in advanced stage ovarian cancer without compromising OS or PFS and offering better quality of life.…”

Section: Discussionsupporting

confidence: 85%

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Role of Neoadjuvant Chemotherapy (NACT) Followed by Surgical Cytoreduction in Advanced Epithelial Ovarian Cancer

Batra

Nayak

Dave

2012

J Obstet Gynecol India

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Objectives To study the role of neoadjuvant chemotherapy (NACT) followed by surgical cytoreduction in the management of advanced epithelial ovarian cancers. Methods A prospective hospital based study of patients with advanced epithelial ovarian cancers (stage III and IV) was conducted at Gujarat Cancer & Research Institute, Ahmedabad during August 2008 to August 2010. Total 50 patients were treated with NACT followed by surgical cytoreduction and followed up till August 2010. Response to NACT, optimal cytoreduction rate and overall response rate were analyzed. Results There were 43 patients (86%) with stage III disease and 7 (14%) with stage IV disease. All patients were given NACT and after NACT, complete response occurred in 17 patients (34%), 27 (54%) had partial response. Optimal surgical cytoreduction could be achieved in 36(72%) of the patients. The median follow up was 19 months.Conclusions NACT followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers.

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Section: Discussionsupporting

confidence: 85%

“…ORR was 88% with CR of 34% and PR of 54%, which was similar to findings by Mazzeo et al [8], Le et al [9], Chan et al [13], Ansqucr et al [14].…”

Section: Discussionmentioning

confidence: 99%

Role of Neoadjuvant Chemotherapy (NACT) Followed by Surgical Cytoreduction in Advanced Epithelial Ovarian Cancer

Batra

Nayak

Dave

2012

J Obstet Gynecol India

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“…The radicality of procedures necessary to obtain this state of residuum does not appear to influence outcomes [1,5,9]. Although the concept of neoadjuvant chemotherapy has been championed in some American institutions [10] and in many centers in Europe [11], this practice is not currently considered standard of care for women able to tolerate surgical resection. Recently, Bristow and Chi reported a median reduction in survival of over 4 months for each cycle of pre-operative chemotherapy [12].…”

Section: Introductionmentioning

confidence: 99%

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Dowdy

Loewen

Aletti

et al. 2008

Gynecologic Oncology

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Objective-To describe the technique of diaphragmatic peritonectomy (DP) for ovarian cancer cytoreduction and to assess associated morbidity.Methods-Retrospective review yielded 56 patients who underwent DP as part of a cytoreductive procedure for primary or recurrent ovarian cancer between 1988 and 2004. Patients who underwent diaphragmatic resection, removal of diaphragmatic implants with CUSA, cautery, curette, or finger fracture, and patients with pseudomyxoma were excluded from analysis.Results-DP was performed as a component of primary or secondary cytoreduction in 37 (66%) and 19 (34%) patients, respectively. Extended procedures including bowel resection, hepatic resection, splenectomy, or radical hysterectomy were performed with DP in 47 patients (82%). Resection of all disease > 1 cm was achieved in 95% (microscopic residuum in 43%). For those undergoing primary cytoreduction, median survival was 59 months and 5-year survival was 49% with median follow-up of 34 months. When performed for recurrent ovarian carcinoma, 5-year survival was 16% and median survival was 23 months. No intra-operative complications could be specifically attributed to DP. Post-operative complications included a 30% rate of pleural effusion which was associated with entry into the pleural space during DP (p<0.0001); thoracentesis was required in 12.5%.Conclusions-Diaphragmatic metastases are a common obstacle to optimal cytoreduction for patients with ovarian cancer. When necessary, utilizing DP in concert with other extended procedures to obtain maximal cytoreduction is associated with excellent survival. It should be recognized that DP is associated with an increased incidence of post-operative pleural effusion, particularly when the pleural space is entered.

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“…This approach was introduced into the management of ovarian cancer at the end of the 1980s 14 , initially for women who were judged medically unfit to tolerate aggressive debulking surgery. Subsequently, neoadjuvant chemotherapy was advocated especially for the treatment of stage iv ovarian cancer, for patients with a very high metastatic tumour load, or for patients with poor general condition 15,16 . Furthermore, recent data (presented in abstract form) from the European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group (eortc gcg) in cooperation with the ncic Clinical Trials Group (ctg) (eortc 55971/ctg ov.13) suggest that, in stage iiic-iv ovarian cancer, neoadjuvant chemotherapy followed by debulking surgery produces overall survival and progressionfree survival (pfs) outcomes that are similar to, but with less toxicity than, those seen with standard primary debulking surgery followed by chemotherapy 17 .…”

Section: "Neoadjuvant" Chemotherapy and Debulking Surgerymentioning

confidence: 99%

Phase II/III Study of Intraperitoneal Chemotherapy after Neoadjuvant Chemotherapy for Ovarian Cancer: NCIC CTG OV.21

et al. 2011

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Despite the efficacy of intravenous (IV) platinum and paclitaxel chemotherapy, more than 75% of patients with stage iii and iv eoc ultimately relapse and die of their disease 2 . IntraperItoneal ChemotherapyThe peritoneal cavity is the principle site of spread and recurrence in women with eoc. Intraperitoneal (IP) administration of chemotherapy, as a means of increasing the dose intensity delivered to the tumour while minimizing systemic toxicity, is therefore an attractive therapeutic approach 3 . Advantages of this administration route include high IP concentration and longer half-life of the drug in the peritoneal cavity than are observed with IV administration. For cisplatin, the most commonly used IP chemotherapeutic agent, IP administration translates into an exposure in the peritoneal cavity that is greater by a factor of 10-20 than is achievable with the IV route 4 . Publication of the Gynecologic Oncology Group (gog) 172 study, which demonstrated a significant overall survival benefit (17.4 months) for IP paclitaxel-IV cisplatin over conventional IV chemotherapy in women with stage iii eoc undergoing "upfront" optimal (≤1 cm) debulking surgery prompted a re-evaluation of IP chemotherapy 5 . The U.S. National Cancer Institute (nci) reviewed data from seven randomized trials comparing IV-IP with standard IV administration of chemotherapy in women who had undergone primary debulking surgery (Table i). On average, IP-IV chemotherapy was associated with a 21.6% decrease in risk of death (hazard ratio: 0.78; 95% confidence interval: 0.69 to 0.89) [5][6][7][8][9][10][11][12] . They concluded that IP-IV chemotherapy should be considered a standard of care for a select group of women with eoc.Despite the favourable outcomes, IP chemotherapy has not been universally adopted. In all seven studies, toxicity was higher in the experimental arm, particularly when considered in comparison with standard IV carboplatin and paclitaxel. Dropout rates were high, with completion rates ranging from 71% (gog 114) to 42% (gog 172). The optimal aBStraCt Three large randomized clinical trials have shown a survival benefit in women with stage iii epithelial ovarian cancer (eoc) who receive intraperitoneal (IP) chemotherapy after optimal primary debulking surgery. The most recent Gynecologic Oncology Group study, gog 172, showed an improvement in median overall survival of approximately 17 months. That result led to a U.S. National Cancer Institute (nci) clinical announcement recommending that IP chemotherapy be considered for this group of women with eoc. However, IP chemotherapy is associated with increased toxicity, and rates for completion of treatment are low (42% in gog 172). The optimal IP regimen and duration of treatment has yet to be defined. Women undergoing chemotherapy before optimal debulking surgery were not included in the studies or in the nci clinical announcement. The National Cancer Institute of Canada Clinical Trials Group has developed a protocol for a randomized phase ii/iii study which will examine whether I...

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Neoadjuvant chemotherapy for unresectable ovarian carcinoma

Cited by 34 publications

References 6 publications

Role of Neoadjuvant Chemotherapy (NACT) Followed by Surgical Cytoreduction in Advanced Epithelial Ovarian Cancer

Role of Neoadjuvant Chemotherapy (NACT) Followed by Surgical Cytoreduction in Advanced Epithelial Ovarian Cancer

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Phase II/III Study of Intraperitoneal Chemotherapy after Neoadjuvant Chemotherapy for Ovarian Cancer: NCIC CTG OV.21

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