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

Abstract

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.

Neoadjuvant chemotherapy followed by surgical cytoreduction in advanced epithelial ovarian cancer

“…Many authors have reported an optimal cytoreduction rate of 60-75% following NACT in nonrandomized trials. [13][14][15][16] In our study, optimal cytoreduction rate was 72%, which is similar to that reported in the literature using NACT. The surgical cytoreduction was 100% in patients with clinical and radiological complete response, 84% in patients with partial response and 0% in patients with no response to NACT.…”

“…Initial reports of NACT in advanced ovarian cancers have reported a response rate of 70-80% [13,15,16] and an acceptable toxicity profile. [27,28] In our study, all patients could complete planned NACT with acceptable toxicity profile.…”

“…[13,15,16,32,33] As far as the factors affecting survival in advanced ovarian cancer, many studies have consistently shown amount of residual disease to be a significant prognostic factor. [9,10] Multivariate analysis of factors affecting survival in the current study has shown that the degree of cytoreduction was the only factor affecting overall survival.…”

“…Recently, neoadjuvant chemotherapy (NACT) has been advocated for patients with advanced ovarian cancer with an aim to improve resectability rates and survival. [13][14][15][16] Till now there are no definite guidelines regarding the role of NACT in advanced ovarian cancer. In this study, we have reviewed our experience of neoadjuvant chemotherapy followed by surgical cytoreduction in 82 patients with advanced epithelial ovarian cancer.…”

HER2 Expression in Ovarian Mucinous Carcinomas in Tunisia

“…It has a poor prognosis in the advanced stages and responds poorly to conventional chemotherapy (paclitaxel/carboplatin) (Kurman and Seidman, 2000;Hess et al, 2004;Gurung et al, 2013). An efficient treatment is not yet available (Pectasides et al, 2005).…”