Neoadjuvant chemotherapy in advanced ovarian cancer: a case-control study

Abstract

The aim of this study was to compare the outcome of patients with advanced ovarian carcinoma treated with neoadjuvant chemotherapy (NACT) with those treated conventionally with primary debulking surgery. From 1994 to 2003, all consecutive cases of advanced-stage epithelial ovarian carcinoma treated with NACT at the University of Bari were identified. A well-balanced group of women who underwent primary debulking surgery followed by platinum-based chemotherapy was selected as controls. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival. Thirty women with advanced-stage epithelial ovarian carcinoma were treated with NACT and compared to 30 patients who underwent primary debulking surgery. Patients in the NACT were significantly older and had a poorer performance status compared to the controls. However, no statistical difference was observed in overall disease-specific survival (P= 0.66) and disease-free survival (P= 0.25) between the two groups. Although patients in the NACT group are significantly older and have a poorer performance status, this treatment modality does not compromise survival. Prospective randomized trials comparing NACT to conventional treatment to determine the quality of life and cost/benefit outcomes are now appropriate for women presenting advanced epithelial ovarian cancer.

Role of Neoadjuvant Chemotherapy in the Management of Advanced Ovarian Cancer

“…Inciura et al (2006) retrospective analysis of 213 cases ovarian cancer patients received neoadjuvant chemotherapy and 361 patients treated by standard mode therapy, results showed that there was not significant differences between the two groups in OS and PFS (p>0.05). Loizzi et al (2005) founded that the median survival time, median progression free survival time and 3-years survival rate of neoadjuvant chemotherapy patients compared with the standard treatment for patients had no significant difference.…”

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.…”

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

“…Results of these studies showed that NAC may increase the number of patients suitable for interval cytoreductive surgery by reducing tumor burden and reducing preoperative morbidity [12][13][14][15][16][17][18][19]. Thus, because of recent advances in chemotherapy, NAC followed by interval debulking surgery and further chemotherapy has become an alternative treatment for these patients.…”