Site of residual disease does not predict recurrence patterns in epithelial ovarian cancer patients undergoing primary debulking surgery

ObjectiveThe management of women with advanced-stage serous ovarian cancer includes a combination of surgery and chemotherapy. The choice of treatment with primary debulking surgery or neoadjuvant chemotherapy varies by institution. The objective of this study was to report 5-year survival outcomes for ovarian cancer patients treated at a single institution with primary debulking surgery or neoadjuvant chemotherapy.MethodsThis study included a retrospective chart review of 303 patients with stage IIIC or IV serous ovarian carcinoma diagnosed in Calgary, Canada. The patients were categorized into 1 of the 2 treatment arms: primary debulking surgery or neoadjuvant chemotherapy. The 5-year ovarian cancer–specific survival rates were estimated using Kaplan-Meier curves.ResultsAmong the 303 eligible patients, 142 patients (47%) underwent primary debulking surgery, and 161 patients (53%) were treated with neoadjuvant chemotherapy. Five-year survival was better for patients undergoing primary debulking surgery (39%) than for patients who received neoadjuvant chemotherapy (27%; P = 0.02). Women with no residual disease experienced better overall survival than those with any residual disease (47% vs. 26%, respectively; P = 0.0002). This difference was significant for those who had primary debulking surgery (P = 0.0004) but not for the patients who received neoadjuvant chemotherapy (P = 0.09). Women who received intraperitoneal chemotherapy had better overall survival as compared with patients who received intravenous chemotherapy (44% vs 30%, respectively; P = 0.002).ConclusionsOur findings suggest that among women with no residual disease, survival is better among those who undergo primary debulking surgery than treatment with neoadjuvant chemotherapy. The latter should be reserved for women who are deemed not to be candidates for primary debulking surgery.

Download Full-text

Primary Surgery or Interval Debulking for Advanced Epithelial Ovarian Cancer: Does It Matter?

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000241 ◽

2014 ◽

Vol 24 (8) ◽

pp. 1420-1428 ◽

Cited By ~ 18

Author(s):

Algirdas Markauskas ◽

Ole Mogensen ◽

René dePont Christensen ◽

Pernille Tine Jensen

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Survival Benefit ◽

Statistical Difference ◽

Residual Disease ◽

Operating Time ◽

Debulking Surgery ◽

Primary Debulking Surgery ◽

Surgical Complexity ◽

Advanced Epithelial Ovarian Cancer

ObjectiveThe aim of the present study was to investigate the surgical complexity, the postoperative morbidity, and the survival of the women after primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for advanced epithelial ovarian cancer.Materials and MethodsWe consecutively included all patients who underwent debulking surgery at our institution between January 2007 and December 2012 for stages IIIc and IV of epithelial ovarian cancer.ResultsOf the 332 patients included, 165 (49.7%) underwent PDS, and 167 (50.3%) had NACT-IDS. Complete intraperitoneal cytoreduction was achieved in 70.9% after PDS and in 59.9 % after NACT-IDS. Residual disease of greater than 1 cm was left in 18.5% and 27.5% after PDS and NACT-IDS, respectively. Compared with NACT-IDS, PDS was associated with higher surgical complexity (P < 0.001), longer operating time (P < 0.001), greater blood loss (P < 0.001), longer hospitalization (P = 0.001), and a higher rate of major postoperative complications (26.7% vs 16.8%). No statistical difference in the median overall survival (OS) was found between the patients having complete cytoreduction and residual disease of 1 cm or less after NACT-IDS. Furthermore, no statistical difference in the median OS was found between the patients with macroscopic residual disease (≤1 vs >1 cm) after NACT-IDS. Patients with residual disease of greater than 1 cm after PDS had a median OS of 15 months.ConclusionsWe suggest that NACT-IDS may be a better treatment alternative for the group of highly selected women not suitable for PDS, where expected suboptimal cytoreduction does not have any appreciable survival benefit and exposes them for unnecessary risks. A substantial number of women who receive either PDS or NACT-IDS have greater than 1 cm of tumor tissue left after the operation. These women probably have no survival benefit from the operation, and future studies should focus on how to select these women preoperatively.

Download Full-text