What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer?

Chiva, Luis; Lapuente, Fernando; Castellanos, Teresa; Alonso, Sonsoles; González-Martín, Antonio

doi:10.1245/s10434-015-5051-9

Cited by 56 publications

(76 citation statements)

References 40 publications

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“…In contrast, debulking to small residuals has not prognostic impact after NACT (supplement of [66]) and even an increase of the complete resection rate of about 20% following NACT did not alter prognosis [65,66]. This phenomenon of a discrepancy between PDS and NACT-IDS with respect to the prognostic impact of cytoreduction has been nicely summarized in a recently published comprehensive overview [24]. This review reports for FIGO IV disease and complete resection an inferior median OS for patients in the NACT-IDS group leading to 2.5 years shorter survival compared to the PDS cohort (32 months versus 63 months).…”

Section: Surgerymentioning

confidence: 95%

“…The incidence of FIGO stage IV ovarian cancer seems to raise over the past decades, being reported as 12.7% [22] in the nineties, over 15.4% [4] 1976 [14] 1988 [4] 2013 [15] I 24]. Are we really facing an increase of FIGO IV due to increasing tumor aggressiveness or is this phenomenon a consequence of improved pre-operative diagnostic and/or more comprehensive staging?…”

Section: Diagnosis and Impact Of Enhanced Staging On Figo Stagementioning

confidence: 99%

See 1 more Smart Citation

FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited

Ataseven

Chiva

Harter

et al. 2016

Gynecologic Oncology

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Section: Surgerymentioning

confidence: 95%

Section: Diagnosis and Impact Of Enhanced Staging On Figo Stagementioning

confidence: 99%

FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited

Ataseven

Chiva

Harter

et al. 2016

Gynecologic Oncology

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“…As a result, the debate on the role of PDS and IDS has been reopened, based on the difficulty of achieving an RT "equal to zero" in primary cytoreductive surgery and the morbi-mortality associated to it. For this reason, several studies in favor of PDS and IDS have been published, taking into account the fact that the rates of RT = 0 can vary widely in literature, anywhere from 15 to 85% depending on the center, hence the ongoing debate [14,15,[24][25][26][27][28][29][30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, these studies have been widely criticized, since they have major flaws. As a result, NACT is one of the most widely discussed topics among ovarian cancer experts [7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Impact of Laparoscopy to Assess Resectability in Stage IIIC Epithelial Ovarian, Tubal and Peritoneal Cancer Patients

Sánchez-Iglesias

Pérez-Benavente

Correa-Paris

et al. 2018

Gynecol Obstet Invest

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Aims: To evaluate overall survival (OS) and progression-free survival (PFS) in patients with stage IIIC epithelial ovarian, tubal and peritoneal cancer (EOC) who underwent a laparoscopy to assess surgical resectability prior to Primary Debulking Surgery (PDS) or Interval Debulking Surgery (IDS). Methods: Retrospective cohort study that included all women with stage IIIC EOC treated at our center between 2000 and 2010. Patients were classified in groups: PDS, neoadjuvant chemotherapy (NACT) with IDS, NACT without IDS; and then sub-classified based on residual tumor (RT). A laparoscopy to assess resectability was performed before PDS and IDS. Results: Among 111 patients included, 66 underwent PDS, and 45 were treated with NACT, 80% of them receiving subsequent IDS. OS was 75.6 months in the PDS group, and 52.8 months for IDS group (p = 0.100); the PFS was 30 months and 19.2 months respectively (p = 0.049). Median OS was 104.4 and 52.8 months for patients with optimal cytoreduction (RT = 0) in the PDS and IDS group respectively (p < 0.05). Laparoscopy did not modify the preoperative consideration for PDS; however, 9 laparotomies were avoided based on laparoscopic findings after NACT. Conclusion: Laparoscopy for the assessment of surgical resectability in stage IIIC EOC has no impact on survival; but it still could be useful for the reduction of unnecessary laparotomies after NACT.

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“…8 Although the study was not randomized, these findings add to the abundant clinical experience that patients who undergo PDS appear to have a better outcome in specialized, high-volume centers. 6,[9][10][11][12] The two main phase III trials that have led to the broad implementation of NAC in AOC are the European Organisation for Research and Treatment of Cancer (EORTC) Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Cancer trial 2 and Primary Chemotherapy Versus Primary Surgery for Newly Diagnosed Advanced Ovarian Cancer (CHORUS) trial. 3 Both trials have generated findings that demonstrate a noninferior oncologic performance of NAC-IDS with lower surgical morbidity and mortality scores.…”

mentioning

confidence: 99%

Value of Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer: A European Perspective

Fotopoulou

Sehouli

Aletti

et al. 2017

JCO

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The timing of debulking surgery in advanced ovarian cancer (AOC) has been the focus of debate and controversy in the international community for almost a decade. [1][2][3][4] Although supporters of primary debulking surgery (PDS) advocate significantly better overall survival (OS) and progression-free survival rates, with even a significantly favorable impact on the patterns of relapse, 4 opponents argue higher morbidity in a highly heterogeneous and often fatal disease.1-3 For more than two decades, we have known that each 10% increase in maximal cytoreduction is associated with a 5.5% increase in median survival, even after controlling for all other known patient-and tumor-specific variables. 5,6 However, because of the unusual tumor biology and clinical behavior of AOC, with a typical diffuse peritoneal dissemination, in the majority of cases complete debulking is associated with multivisceral resections that require extensive surgical expertise, training, and infrastructural support to not lead to an exponential increase in morbidity. 7Neoadjuvant chemotherapy (NAC) and interval debulking surgery (IDS) have been considered as ways to reduce surgical morbidity; however, the oncologic safety of these approaches has never been proven in a maximal effort setting of high surgical expertise.2,3 The inconsistent quality of the surgical trials that have addressed this matter so far; the broad variation in practice nationally and internationally; and the still unanswered questions of fragility scores, biomarkers, and valid predictors of operability have led to strong polarization and controversy worldwide, which gives a clear signal of the need for further evidence.As a network of European institutions dedicated to highquality gynecologic oncology care, we address some key points about this highly controversial topic and express some serious concerns related to a potential patient's compromise through suboptimal therapeutic strategies. Our statement is timed to the recent publication of the Society of Gynecologic Oncology and ASCO statement about the use of NAC in AOC, which provides guidance on the optimal timing of surgery and identifies diagnostic tools that facilitate the patient selection process.

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What Should We Expect After a Complete Cytoreduction at the Time of Interval or Primary Debulking Surgery in Advanced Ovarian Cancer?

Abstract: Complete cytoreduction after IDS yields a inferior outcome in terms of median survival than PDS of almost 2 years. Despite the higher rate of complete resection, IDS apparently fails to improve the results obtained by primary debulking.

Cited by 56 publications

References 40 publications

FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited

FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited

Impact of Laparoscopy to Assess Resectability in Stage IIIC Epithelial Ovarian, Tubal and Peritoneal Cancer Patients

Value of Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer: A European Perspective

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