Neoadjuvant chemotherapy in elderly women with ovarian cancer: Rates of use and effectiveness

Meyer, Larissa A.; He, Weiguo; Sun, Charlotte C.; Zhao, Hui; Wright, Alexi A.; Suidan, Rudy S.; Dottino, Joseph; Rauh‐Hain, J. Alejandro; Lu, Karen H.; Giordano, Sharon H.

doi:10.1016/j.ygyno.2018.06.020

Cited by 38 publications

(26 citation statements)

References 18 publications

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“…Furthermore, NACT has been shown to have decreased intraoperative blood losses, is less likely to receive perioperative blood transfusions with decreased number of units received, has earlier times to ambulation and return of intestinal function, and has shorter LOS [28,29,31,32,33,34]. NACT is also associated with significantly fewer intestinal diversions (10.8% vs. 23.3%, p < 0.0001) [35]. NACT is becoming increasingly common in the United States as quality and safety data continues to favor NACT over PCS [36].…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

et al. 2019

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Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

et al. 2019

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“…Summary of major U.S. observational studies is shown in Table 2. When it comes to "real-world practice", the results are heterogeneous across the study populations [6][7][8][9][10][11]. For instance, results from a multicenter retrospective study among the National Cancer Institute designated centers in the United States noted better clinical outcomes in patients treated with pTRS, but higher complete cytoreduction rates in patients treated with NACT.…”

Section: Observational Studies Evaluating Nactmentioning

confidence: 99%

“…The use of NACT has increased annually by 10.3% between 2011 and 2016 compared with an annual increase of 7.9% between 2006 and 2011 [7]. The results of NACT trends in several major U.S. observational studies are displayed in Figure 1 [6][7][8][9][10][11]. Overall, the NACT use has increased significantly in recent years particularly for patients with stage IV disease.…”

Section: Introductionmentioning

confidence: 99%

Emerging Trends in Neoadjuvant Chemotherapy for Ovarian Cancer

Patel

Iyer

Matsuzaki

et al. 2021

Cancers

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Epithelial ovarian cancer remains a leading cause of death amongst all gynecologic cancers despite advances in surgical and medical therapy. Historically, patients with ovarian cancer underwent primary tumor reductive surgery followed by postoperative chemotherapy; however, neoadjuvant chemotherapy followed by interval tumor reductive surgery has gradually become an alternative approach for patients with advanced-stage ovarian cancer for whom primary tumor reductive surgery is not feasible. Decision-making about the use of these approaches has not been uniform. Hence, it is essential to identify patients who can benefit most from neoadjuvant chemotherapy followed by interval tumor reductive surgery. Several prospective and retrospective studies have proposed potential models to guide upfront decision-making for patients with advanced ovarian cancer. In this review, we summarize important decision-making models that can improve patient selection for personalized treatment. Models based on clinical factors (clinical parameters, radiology studies and laparoscopy scoring) and molecular markers (circulating and tumor-based) are useful, but laparoscopic staging is among the most informative diagnostic methods for upfront decision-making in patients medically fit for surgery. Further research is needed to explore more reliable models to determine personalized treatment for advanced epithelial ovarian cancer.

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ObjectiveNeoadjuvant chemotherapy for advanced ovarian cancer is associated with reduced morbidity in the elderly (Meyer et al, 2018). Spontaneous colonic perforation often leads to multisystem organ failure and death (Carter and Durfee, 2007; Rose and Piver, 1995).

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confidence: 99%

Laparoscopic diverting loop ileostomy for spontaneous colon perforation in advanced ovarian cancer

Schorge

2019

Gynecologic Oncology Reports

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ObjectiveNeoadjuvant chemotherapy for advanced ovarian cancer is associated with reduced morbidity in the elderly (Meyer et al., 2018). Spontaneous colonic perforation often leads to multisystem organ failure and death (Carter and Durfee, 2007; Rose and Piver, 1995).MethodsA 76-year old woman with stage IIIC disease initiated carboplatin AUC 5 and paclitaxel 175 mg/m2 with unanticipated development of profound neutropenia. She clinically deteriorated by day nine and CT scan revealed a large volume of free air. Emergent surgery was performed.ResultsDiagnostic laparoscopy confirmed the presence of intra-abdominal stool and extensive inflammatory exudate (Video). The likelihood of identifying the site of perforation appeared remote, but pelvic tumor encasement was highly suggestive of a sigmoid origin. The stool was evacuated, the exudate gently debrided and the terminal ileum partially mobilized. Copious irrigation was performed with drain placement and the pneumoperitoneum was decompressed. The right lower abdominal wall trocar incision was extended so that the ileal segment could be brought out and matured. She was discharged to rehab on postoperative day 2 to continue a two week course of broad spectrum antibiotics. Single-agent carboplatin was resumed within a month. Uncomplicated ileostomy takedown with parastomal hernia repair was performed between cycles five and six. The patient is currently in remission.ConclusionBowel perforation in the elderly, presenting with cachexia and treatment-induced pancytopenia for advanced ovarian cancer, is often a harbinger of early death. Selected patients may benefit from a minimally invasive approach by an experienced gynecologic oncologist instead of vertical laparotomy, abdominal washout, diversion and the potential sequelae of an open abdomen.

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Neoadjuvant chemotherapy in elderly women with ovarian cancer: Rates of use and effectiveness

Cited by 38 publications

References 18 publications

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Emerging Trends in Neoadjuvant Chemotherapy for Ovarian Cancer

Laparoscopic diverting loop ileostomy for spontaneous colon perforation in advanced ovarian cancer

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