Prognostic factor on optimal debulking surgery by maximum effort for stage IIIC epithelial ovarian cancer

Abstract Objective To compare the chemoresistance and survival in patients with stage IIIC or IV epithelial ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS). The clinical characteristics of patients who benefited from NACT were further evaluated. Methods We retrospectively analyzed 220 patients who underwent NACT followed by IDS or PDS from January 2002 to December 2016. Differences in clinicopathological features, chemoresistance and prognosis were analyzed. Results The incidence rate for optimal cytoreduction and chemoresistance in the NACT group was relatively higher than PDS group. No differences were observed in progression free survival or overall survival. Patients without macroscopic RD in NACT group (NACT-R0) had a similar prognosis compared to those in PDS group who had RD<1 cm, and a relatively better prognosis compared to the PDS group that had RD ≥ 1 cm. The survival curve showed that patients in NACT-R0 group that were chemosensitive seemed to have a better prognosis compared to patients in PDS group that had RD. Conclusion Patients without RD after PDS had the best prognosis, whereas patients with RD after NACT followed by IDS had the worst. However, even if patients achieved no RD, their prognosis varied depending on chemosensitivity. Survival was better in patients who were chemosensitive compared to thosewho underwent PDS but had RD. Hence evaluating the chemosensitivity and feasibility of complete cytoreduction in advance is crucial.

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Racial disparities in women with stage IIIC and IV epithelial ovarian cancer receiving neoadjuvant chemotherapy versus primary debulking surgery - A National Cancer Database study

Gynecologic Oncology ◽

10.1016/j.ygyno.2019.03.206 ◽

2019 ◽

Vol 154 (1) ◽

pp. e20

Author(s):

Gabrielle T. Whitmore ◽

Amin Ramzan ◽

Jeanelle Sheeder ◽

Saketh Guntupalli

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Racial Disparities ◽

National Cancer Database ◽

Debulking Surgery ◽

Stage Iiic ◽

Database Study ◽

Primary Debulking Surgery

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Preoperative evaluation of epithelial ovarian cancer with multidetector computed tomography and its correlation with surgical outcome

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.16051 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 16051-16051

Author(s):

C. SH ◽

S. Thulkar ◽

D. Srivastava ◽

L. Kumar ◽

R. Hariprasad ◽

...

Keyword(s):

Ovarian Cancer ◽

Ct Scan ◽

Epithelial Ovarian Cancer ◽

Predictive Value ◽

Preoperative Evaluation ◽

Residual Tumour ◽

Optimal Cytoreduction ◽

Ct Scanner ◽

Debulking Surgery ◽

Optimal Debulking

16051 Background: In the management of epithelial ovarian cancer (EOC), optimum debulking surgery (residual tumour of 1 cm or less) is the most important prognostic factor and is associated with higher survival We conducted a prospective study to evaluate the role of Multidetector (MD) CT scan to predict optimal debulking in advanced EOC. Methods: Between December, 2004 and October, 2006, 38 previously untreated patients (median age-50 years, range 26 to 70) were evaluated with contrast- enhanced MD CT scan of abdomen and pelvis. All CT scans were performed on four-slice MD CT scanner with thin slice image acquisition. Multiplanar coronal, sagital or oblique images were constructed and all images were reviewed by at least 2 radiologists. The extent of disease was determined and mapped for all areas of abdomen and pelvis. Patients underwent primary debulking surgery in which total abdominal hysterectomy, bilateral salphingo-oophorectomy, omentectomy and optimal cytoreduction was done. CT scan films were reviewed and compared with surgical findings. A CT scan scoring system was developed to predict the optimum debulking using 10 parameters: ascites, pelvic, peritoneal deposits, large bowel, small bowel, omentum, diaphragm, liver, lymphadenopathy and lesser sac. Each factor was assigned a score of 0 to 2. The statistical analysis was done using SPSS version 11 and EpiInfo 6 software. Results: The mean interval between CT scan and surgery was 11 days. 18 of 38 patients had a CT score = 7; all 18 had sub-optimal debulking. Of remaining 20 patients with CT score <7, 17(44.7%) had optimum and 3 had sub-optimal cytoreduction. The sensitivity and specificity was 85.7% (95% CI 62.6–96.2) and 100% (95% CI 77.1–100), respectively. It had positive predictive value of 100% and negative predictive value of 85% with accuracy of 92% in identification of patients who would not benefit from surgery. Presence of tumor at gall bladder fossa, porta hepatis, ligament teres, spleen , stomach, pancreas, lesser sack and pelvic side walls was associated with sub-optimal debulking. Conclusions: Pre-operative CT scan scoring helps to identify patients who are likely to have sub-optimal debulking and may be candidates for neoadjuvant chemotherapy No significant financial relationships to disclose.

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Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072213 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2213 ◽

Cited By ~ 6

Author(s):

Chen-Yu Huang ◽

Min Cheng ◽

Na-Rong Lee ◽

Hsin-Yi Huang ◽

Wen-Ling Lee ◽

...

Keyword(s):

Ovarian Cancer ◽

Figo Stage ◽

Weekly Paclitaxel ◽

Front Line ◽

Debulking Surgery ◽

Stage Iiic ◽

Gynecology And Obstetrics ◽

Dose Dense ◽

Optimal Debulking ◽

Line Chemotherapy

The use of weekly chemotherapy for the treatment of patients with advanced-stage serous-type epithelial Tubo-ovarian cancer (ETOC), and primary peritoneal serous carcinoma (PPSC) is acceptable as the front-line postoperative chemotherapy after primary cytoreductive surgery (PCS). The main component of dose-dense chemotherapy is weekly paclitaxel (80 mg/m2), but it would be interesting to know what is the difference between combination of triweekly cisplatin (20 mg/m2) or triweekly carboplatin (carboplatin area under the curve 5-7 mg/mL per min [AUC 5-7]) in the dose-dense paclitaxel regimen. Therefore, we compared the outcomes of women with Gynecology and Obstetrics (FIGO) stage IIIC ETOC and PPSC treated with PCS and a subsequent combination of dose-dense weekly paclitaxel and triweekly cisplatin (paclitaxel–cisplatin) or triweekly carboplatin using AUC 5 (paclitaxel–carboplatin). Between January 2010 and December 2016, 40 women with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC EOC, FTC, or PPSC were enrolled, including 18 treated with paclitaxel–cisplatin and the remaining 22 treated with paclitaxel–carboplatin. There were no statistically significant differences in disease characteristics of patients between two groups. Outcomes in paclitaxel–cisplatin group seemed to be little better than those in paclitaxel–carboplatin (median progression-free survival [PFS] 30 versus 25 months as well as median overall survival [OS] 58.5 versus 55.0 months); however, neither reached a statistically significant difference. In terms of adverse events (AEs), patients in paclitaxel–carboplatin group had more AEs, with a higher risk of neutropenia and grade 3/4 neutropenia, and the need for a longer period to complete the front-line chemotherapy, and the latter was associated with worse outcome for patients. We found that a period between the first-time chemotherapy to the last dose (6 cycles) of chemotherapy >21 weeks was associated with a worse prognosis in patients compared to that ≤21 weeks, with hazard ratio (HR) of 81.24 for PFS and 9.57 for OS. As predicted, suboptimal debulking surgery (>1 cm) also contributed to a worse outcome than optimal debulking surgery (≤1 cm) with HR of 14.38 for PFS and 11.83 for OS. Based on the aforementioned findings, both regimens were feasible and effective, but maximal efforts should be made to achieve optimal debulking surgery and following the on-schedule administration of dose-dense weekly paclitaxel plus triweekly platinum compounds. Randomized trials validating the findings are warranted.

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