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

Batra, Sonia; Nayak, Himanshu Bhusana; Dave, Kalpna S.

doi:10.1007/s13224-011-0106-8

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Mazzeo et al (2003) [10] Sonia et al (2010) [11] Present study (n=34 and present study, it showed that majority of patients were under Partial response 33, 27 and 31 respectively [10] . When patients with stable disease were considered Sonia et al, mazeo at al and the present study showed that there were 8 patients, 6 patients and 2 patients respectively [10,11] . When patients with progressive disease was considered mazzeo et al had 3 patients, while present study had only 1 patient.…”

Section: Responsesupporting

confidence: 49%

Neoadjuvant chemotherapy in advanced stage ovarian cancer

Vishwanath¹,

Shetty²,

Beegum³

2018

Int. J. Clin. Obstet. Gynaecol.

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Background: Primary debulking surgery followed by platinum based chemotherapy was the standard therapy for advanced stage of ovarian cancer in the past. Primary debulking could be performed only in 30 to 60% of the patients with advanced ovarian cancer. In patients who had massive ascites, pleural effusion and large abdominal tumor, hence optimal primary debulking with gross residual disease less than 1 cm was difficult without Neoadjuvant chemotherapy (NACT). Hence present day guidelines suggest to give 3 -4 cycles of Neoadjuvant chemotherapy to downstage the disease, which eventually helps the surgeon in obtaining optimal cytoreduction, which may transform into a prolonged disease free and overall survival. Aim:1. To study the radiological response of advanced ovarian cancer by RECIST (Response Evaluation Criteria In Solid Tumors) criteria using CT scan 2. To Evaluate the correlation of CA 125, pre NACT an post NACT. 3. To study the chemotherapy related changes in histopathological evaluation. Materials and Methods: Patients diagnosed as Ca ovary stage III and IV underwent CT imaging and serum CA-125 estimation before and after NACT followed by interval debulking and adjuvant chemotherapy, Response to the Neoadjuvant chemotherapy will be analysed by RECIST criteria. During surgery intra op tumor size is observed and also presence of non-target lesions and documented. The specimen is then sent for histopathological examination to look for chemotherapy related changes. Results:The study was conducted on 34 patients of whom 31 patients had partial response, 1 patient had stable disease and 2 patient had progressive disease after NACT. CA-125 was estimated in these patients prior and after NACT and was found to have reduction in the values which was statistically significant of p value of <0.0001, with mean and standard deviation of pre-operative and post-operative CA-125 being 1808.38± 2205.27 and 111.38± 181.84 respectively. Conclusion: Our present study showed that NACT reduced the tumor burden and it allowed easier and complete surgical cytoreduction and also reduced surgical complications and treatment related deaths and morbidity. This study also showed that CA-125 is one of the best markers in epitheial ovarian cancer as it helps to assess the objective response to chemotherapy. It also helps to know the prognosis of the disease.

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Section: Responsesupporting

confidence: 49%

Neoadjuvant chemotherapy in advanced stage ovarian cancer

Vishwanath¹,

Shetty²,

Beegum³

2018

Int. J. Clin. Obstet. Gynaecol.

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“…In nearly 72% cases in this study, R0 resection was achieved. This is in accordance with various studies: Deo et al 14 and Batra et al 15 (R0 ¼ 72% in each study) and one by Ghisoni et al 16 (R0 ¼ 70%). The rates of optimal debulking surgery in the EORTC trial, 8 CHORUS, 9 JCOG, 17 SCORPION, 12 and Ghisoni et al 16 were 80, 73, 82, 90, and 70%, respectively.…”

Section: Discussionsupporting

confidence: 93%

Critical Analysis of Advanced High-Grade Serous Epithelial Ovarian Cancer in Women: An Experience of 100 Cases from a Regional Cancer Center in Northeast India

Barmon,

Patra,

Nandwani

et al. 2023

South Asian J Cancer

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Ovarian cancer is the sixth most common cancer in women worldwide. Patients with ovarian carcinoma mostly present at an advanced stage with serous type of epithelial ovarian cancers, which is the most lethal of all pelvic malignancies. This study aims to critically analyze high-grade serous epithelial ovarian carcinomas in women from the Northeastern region of India and compare our data with Western literature to modify treatment strategies and improve survival outcomes. This hospital-based retrospective analysis involved data from the records of 100 women with high-grade epithelial ovarian cancer treated primarily with neoadjuvant chemotherapy followed by interval debulking surgery in the department of gynecologic oncology at a tertiary level regional cancer institute from January 2018 to December 2019. The demographic, clinical and pathological profile, and survival outcome were evaluated using descriptive statistics. The overall survival of the study population was calculated using Kaplan–Meier curves using SPSS software (version 24). The majority of women belonged to 41 to 55 years age group. At first presentation to the hospital, 89 and11% patients were in stage III and stage IV of disease, respectively. Clinically, 95% of women had ascites, and 18% had metastasis to lymph nodes. Distant metastasis to lungs and liver was present in 10 and 3% of cases, respectively. A substantial percentage (98%) of women had raised serum Ca125 > 1000 at baseline, ranging from 1,745 to 10,987 IU/mL. Almost two-thirds of the cases had partial-to-complete response to neoadjuvant chemotherapy (78%). In most of the women (72%), there was no residual disease at interval debulking surgery (R0), though 28% women had R1& R2 resection. The median overall survival time was 36 months. High-grade serous ovarian cancer is commonly seen in older age group, but its occurrence in younger population has also been observed. Early diagnosis is crucial in decreasing morbidity and mortality among these patients. Therefore, efforts should be made to identify risk factors for malignancy. Assessing each parameter of statistical information reflecting its own profile may be important for calculating the risk for the development of ovarian cancer, which can help in implementing preventive measures in the future.

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“…In a study by Sonia Batra et al, optimal cytoreduction was achieved in 72% of the patients who underwent NACT followed by IDS, which was comparable to 78% complete cytoreduction rate in the present study. 10 In the EORTC trial (Table 2) by Vergote et al, the OS and PFS survival after NACT and IDS with adjuvant chemotherapy were 30 months and 12 months, respectively, and in the CHORUS trial, the values were 24.5 months and 11.7 months, respectively. 11 In study by Baruah et al, the OS and PFS after NACT followed by IDS and adjuvant chemotherapy were 26 months and 18 months, respectively, and in the present study, the OS and PFS after similar management were 21 and 20 months, respectively (Table 2).…”

Section: Discussionmentioning

confidence: 96%

Surgical and Survival Outcomes with Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Longitudinal Study in a Tertiary Cancer Center

Raghavendrachar¹,

Bhat²,

Dhakaria³

2020

Journal of South Asian Federation of Obstetrics and Gynaecology

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Aims: To evaluate surgical and survival outcomes following neoadjuvant chemotherapy followed by interval debulking surgery (IDS) in advanced epithelial ovarian cancer (AEOCs). Materials and methods: Fifty patients who were diagnosed with stage III-IV ovarian cancer/primary peritoneal cancer/fallopian tube cancer were followed up following three cycles of neoadjuvant chemotherapy and debulking surgery followed by adjuvant chemotherapy in a comprehensive cancer center. This longitudinal study was conducted over four years from 2013-2017. Primary outcome measured was progression-free survival and secondary outcomes that included overall survival and effect of optimal and suboptimal surgeries on survival outcomes. In this study, we compared the difference in survival outcomes following various types of debulking (complete vs optimal vs suboptimal). Results: Among 50 patients who underwent debulking, 78%, 8%, and 14% underwent complete, optimal, and suboptimal debulking, respectively. The mean estimate of progression-free survival (PFS) at 24 months was 20.324 ± 0.97 months (95% CI) and the overall survival was 21.234 ± 0.788 months. There was a significant increase in PFS in those who had complete debulking (21.47 ± 0.95 months, 95% CI 19.6 to 23.3 months) compared to those in optimal debulking (20.53 months) and suboptimal groups (10.3 months) (Log-rank Mantel-Cox = 12.01, p = 0.001). Seventy-eight percent had no postoperative complications while 16% had grade I complications. Grade II, IV, and V complications were 2% each. Conclusion: Neoadjuvant chemotherapy followed by IDS gives better chance of complete debulking and better survival outcomes with acceptable postoperative complications.

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

Cited by 5 publications

References 16 publications

Neoadjuvant chemotherapy in advanced stage ovarian cancer

Neoadjuvant chemotherapy in advanced stage ovarian cancer

Critical Analysis of Advanced High-Grade Serous Epithelial Ovarian Cancer in Women: An Experience of 100 Cases from a Regional Cancer Center in Northeast India

Surgical and Survival Outcomes with Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Longitudinal Study in a Tertiary Cancer Center

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