The Effect of Debulking Surgery after Induction Chemotherapy on the Prognosis in Advanced Epithelial Ovarian Cancer

Burg, M.E.L. van der; Lent, M. van; Buyse, Marc; Kobierska, A; Colombo, Nicoletta; Favalli, G.; Lacave, Ángel J.; Nardi, Mario; Rénard, Josette; Pecorelli, Sërgio

doi:10.1056/nejm199503093321002

Cited by 699 publications

(131 citation statements)

References 18 publications

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“…Interval debulking surgery represents a second cytoreductive operation that follows primary debulking surgery and induction chemotherapy in patients with suboptimal initial cytoreduction [18]. The theoretical advantage of this approach is the increased rate of optimal cytoreduction leading to an increased survival.…”

Section: Interval Debulking Surgerymentioning

confidence: 99%

“…The second trial, conducted by the European Organization for Research and Treatment of Cancer (EORTC), included 278 patients with advanced ovarian cancer, who had undergone an ‘open and close’ operation as primary surgery [18]. After having received three cycles of cisplatin plus cyclophosphamide (CP) chemotherapy, the patients were randomized either to continue with another three cycles of CP or undergo interval debulking surgery followed by three additional cycles of CP.…”

Section: Interval Debulking Surgerymentioning

confidence: 99%

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The Role of Neoadjuvant Chemotherapy in the Treatment of Advanced Ovarian Cancer

Pectasides

Farmakis²,

Koumarianou³

2005

Oncology

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Primary cytoreductive surgery followed by chemotherapy represents the current standard treatment for patients with advanced ovarian cancer. Neoadjuvant chemotherapy followed by interval debulking surgery has been proposed as an alternative approach for the initial management of bulky ovarian cancer, aiming at the improvement of surgical efficiency and patients’ quality of life. According to the hitherto published studies, consisting mainly of retrospective observations, neoadjuvant chemotherapy followed by interval cytoreduction appears to improve the prognosis and quality of life in selected groups of patients. The survival outcome in these patients is similar to that of the conventional approach, or even better in some of the cases. Moreover, patients undergoing debulking surgery after having received neoadjuvant chemotherapy had a reduced perioperative morbidity compared to patients undergoing primary cytoreduction. Concurrently, neoadjuvant chemotherapy provides preoperative knowledge of tumor chemosensitivity, hence allowing the surgeon to choose appropriately aggressive treatment. However, until the results of prospective randomized trials become available, neoadjuvant chemotherapy followed by interval surgery should be applied only to individual cases and primarily in the context of clinical trials.

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Section: Interval Debulking Surgerymentioning

confidence: 99%

Section: Interval Debulking Surgerymentioning

confidence: 99%

The Role of Neoadjuvant Chemotherapy in the Treatment of Advanced Ovarian Cancer

Pectasides

Farmakis²,

Koumarianou³

2005

Oncology

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“…Potential advantages of the alternative approach including carboplatin are: (a) a reduced neurotoxicity (presumably related to lower cumulative dose of cisplatin; (b) the possibility to precociously define the responsivity status of the disease, thus allowing a more rational approach of second-line treatment based on clinical and molecular parameters of drug response (e.g., taxol for resistant p53-mutant tumors); (c) the possible contribution of an aggressive surgical approach as suggested by recent studies [2]. The significant pathological complete response rate and the impressive median survival achieved by the treatment approach including dose intensification of platinum compounds with GSH protection as induction chemotherapy and intervention surgery warrant future evaluation to identify the relative contribution of dose intensification, aggressive surgery and GSH itself.…”

Section: Discussionmentioning

confidence: 99%

“…Although the value of cytoreductive surgery is still a matter of debate [1, 2], the size of residual tumor is widely recognized to be an important prognostic factor [3]. Platinum compounds have proved to be the most active agents.…”

Section: Introductionmentioning

confidence: 99%

Dose Intensification of Platinum Compounds with Glutathione Protection as Induction Chemotherapy for Advanced Ovarian Carcinoma

Böhm¹,

Oriana²,

Spatti³

et al. 1999

Oncology

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Based on previous clinical experience indicating the tolerability and efficacy of high-dose cisplatin with glutathione protection in the treatment of advanced ovarian cancer, this study was undertaken to explore the efficacy and feasibility of an alternative high-dose, platinum-based approach including a combination of high-dose cisplatin plus carboplatin as induction chemotherapy of advanced ovarian carcinoma and intervention surgery. Fifty consecutive eligible patients with untreated stage III or IV epithelial ovarian cancer received 40 mg/m² cisplatin daily on days 1–4 and 160 mg/m² carboplatin on day 5. The cycle was repeated after 28 days. Patients received glutathione (2,500 mg) before each cisplatin or carboplatin administration and standard intravenous hydration. After 2 courses of induction chemotherapy, the patients underwent surgical reevaluation with debulking, when possible, followed by a further 3 cycles of 120 mg/m² cisplatin (i.e. 40 mg/m² daily for 3 consecutive days plus 600 mg/m² cyclophosphamide on day 3) except in instances of lack of response. All eligible patients were assessed for response and toxicity. The toxicity was moderate with lack of significant nephrotoxicity. Neurotoxicity and ototoxicity were acceptable and in no patient was treatment discontinued for those toxic effects. Myelotoxicity was somewhat more severe than that observed with our previous study with high-dose cisplatin and probably related to the addition of carboplatin. Of the 40 responsive patients, 23 (46%) had a pathological complete response and 4 (8%) had a clinical complete response (without second-look laparotomy). The efficacy of the present protocol was also documented by overall survival (median survival >48 months), which appeared to be better than expected with the current therapy in this group with advanced/bulky disease. The impressive efficacy suggests a possible contribution of reduced glutathione itself in improving the outcome, as supported by preclinical studies. The results of this study should be placed in context with current platinum-based therapy including paclitaxel.

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“…Despite the fact that more effective surgery and optimized combinational chemotherapy, i.e. platinum-based drugs combined with taxanes have improved the management of ovarian cancer over the last two decades, the overall cure rate is only 30% [108,130,131,132]. Following primary treatment for ovarian cancer, clinical assessment and CA-125 are routinely used to monitor patients.…”

Section: Cd24mentioning

confidence: 99%

Ovarian cancer: Origin and factors involved in carcinogenesis with potential use in diagnosis, treatment and prognosis of the disease

Záveský

Jancárková²,

Kohoutová³

2011

neo

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Ovarian cancer representing the most lethal gynecologic malignancy escapes from the efforts to manage the disease. We reviewed the current state of the research considering three main concepts on origin of ovarian cancer including epithelialmesenchymal transition, secondary origin from Müllerian system and cancer stem cell hypothesis. Cytogenetic and molecular characteristics of ovarian cancer are focused particularly on microRNA expression studies revealing huge potential in recent years, although other transcriptomic, proteomic, epigenetic, epidemiologic and immunological factors are touched upon, too. Routine and investigated diagnostic and treatment methods are outlined and several factors revealed to be associated with prognosis of the disease. Despite the huge progress on elucidating factors involved in ovarian cancer carcinogenesis, still remains urgent need to improve both the diagnostics as well as the treatment.

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The Effect of Debulking Surgery after Induction Chemotherapy on the Prognosis in Advanced Epithelial Ovarian Cancer

Abstract: Debulking surgery significantly lengthened progression-free and overall survival. The risk of death was reduced by one third, after adjustment for a variety of prognostic factors.

Cited by 699 publications

References 18 publications

The Role of Neoadjuvant Chemotherapy in the Treatment of Advanced Ovarian Cancer

The Role of Neoadjuvant Chemotherapy in the Treatment of Advanced Ovarian Cancer

Dose Intensification of Platinum Compounds with Glutathione Protection as Induction Chemotherapy for Advanced Ovarian Carcinoma

Ovarian cancer: Origin and factors involved in carcinogenesis with potential use in diagnosis, treatment and prognosis of the disease

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