Impact of neoadjuvant chemotherapy on the immune microenvironment in advanced epithelial ovarian cancer: Prognostic and therapeutic implications

AbstractIntroductionResidual disease in ‘normal appearing’ peritoneum is seen in nearly 30% following neoadjuvant chemotherapy for advanced epithelial ovarian cancer. Our goal was to study prospectively, the sequence of response in different regions, the commonest sites of occult residual disease, its incidence in different peritoneal regions and the potential therapeutic implications of these.MethodsThe patterns of response were studied based on the finding of residual disease in cytoreductive surgery specimens on pathological evaluation. A protocol for pathological evaluation was laid down and followed. Informed consent was taken from all patients. A correlation between clinical and pathological findings was made. Sugarbaker’s peritoneal cancer index was used to describe the regional distribution of peritoneal diseaseResultsIn 85 patients treated between July 2018 to June 2019, 83 FIGO stage III-C at diagnosis and 2 stage IV-A. Microscopic disease in ‘normal appearing’ peritoneal regions was seen in 22 (25.2%) and in normal peritoneum around tumor nodules in 30 (35.2%). Regions 4 and 8 of Sugarbaker’s peritoneal cancer index had the highest incidence of residual disease in absence of visible disease and regions 9 and 10 the lowest. The response to chemotherapy occurred in a similar manner in over 95% of the patients-the least common site of residual disease was the small bowel mesentery, followed by upper regions (regions 1-3), omentum and middle regions (regions 0, 4, 8), lower regions (regions 5-7) and lastly the ovaries. Nearly 85% had 4 or more peritonectomies and 67% had 6-7 peritonecomies.ConclusionsComplete resection of involved the peritoneal region could address all the occult disease in a particular region. The role of resection of the entire region as well as ‘normal appearing’ parietal peritoneal regions (or total parietal peritonectomy) during interval cytoreduction should be prospectively evaluated to determine its impact on morbidity and survival.

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Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

Journal of Clinical Medicine ◽

10.3390/jcm10020334 ◽

2021 ◽

Vol 10 (2) ◽

pp. 334

Author(s):

Stephanie Seidler ◽

Meriem Koual ◽

Guillaume Achen ◽

Enrica Bentivegna ◽

Laure Fournier ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Lymph Node Dissection ◽

Prospective Trial ◽

Node Dissection ◽

Advanced Epithelial Ovarian Cancer ◽

The Impact ◽

Systematic Lymph Node Dissection

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.

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