A study of clinicopathologic factors as indicators for early prediction of suboptimal debulking surgery after neoadjuvant chemotherapy in advanced ovarian cancer

5540 Background: Primary debulking surgery (PDS) has been considered the standard of treatment in advanced ovarian cancer, while neoadjuvant chemotherapy, three cycles followed by interval debulking (ID) surgery, is a valid treatment alternative for patients with non-resectable disease. This study aimed to show the efficacy and safety of six cycles of neoadjuvant chemotherapy (N-CT) followed by cytoreduction, a single institution experience. Methods: Aretrospective analysis was performed of all patients (pts) with advanced ovarian cancer treated with platinum based N-CT, between January/2004 and February/2012. Results: 97 pts underwent N-CT in our institution; 78.1% and 18.8% the patients had extensive stage IIIC or IV disease at diagnosis, respectively. Median age 60 years (36 – 82). Histologic types: serous 84.5%, adenocarcinoma not specified 11.3%, endometrioide 1.0%. A median of six cycles of chemotherapy were performed. Patients did not received chemotherapy after debulking surgery. During the treatment 31.4% had grade 3/4 toxicity, the most commonly observed toxicities were hematologic toxicities and nausea, four (4.1%) patients died during chemotherapy due to disease progression. After N-CT 24.7% achieved clinical complete response, 57.7% partial response and 12.4% disease progression. From this cohort 63.1% underwent a complete resection of all macroscopic and microscopic disease (R0). Median length of hospital stay and postoperative ICU stay was 5 and 0.8 days respectively, surgical complications were not common however five (7.1%) patients needed second surgery due to operatory complications and 19 pts (27.1%) needed blood transfusion after debulking. With a median follow up of 21.8 months (0.5-139.7), median overall survival and chemotherapy-free interval were 57,7 and 9,5 months, respectively. Conclusions: Six cycles of neoadjuvant carboplatin and paclitaxel is safe, effective and does not increase perioperative and postoperative complications for patients with stage IIIC-IV not candidates for optimal/R0 PDS. The overall survival of this cohort is higher than those treated with interval debulking surgery.

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Morbidity of Surgery After Neoadjuvant Chemotherapy Including Bevacizumab for Advanced Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31829dc923 ◽

2013 ◽

Vol 23 (7) ◽

pp. 1326-1330 ◽

Cited By ~ 12

Author(s):

Elisabeth Chéreau ◽

Eric Lambaudie ◽

Gilles Houvenaeghel

Keyword(s):

Ovarian Cancer ◽

Postoperative Complications ◽

Neoadjuvant Chemotherapy ◽

Advanced Ovarian Cancer ◽

Median Number ◽

Debulking Surgery ◽

Surgical Safety ◽

Computed Tomographic ◽

Gynecology And Obstetrics ◽

Grade 3

ObjectiveNeoadjuvant chemotherapy followed by interval debulking surgery is an alternative for the management of advanced ovarian cancer (AOC). Owing to unresectable disease at initial evaluation, some patients received bevacizumab in addition to neoadjuvant chemotherapy. The aim of this study was to evaluate the safety and postoperative course of patients who had received bevacizumab before debulking surgery for AOC.MethodsIn 2012, we identified all patients with AOC who had received neoadjuvant bevacizumab before debulking surgery. We recorded patients’ characteristics, surgical course, and postoperative complications.ResultsFive patients were identified, of whom 80% were International Federation of Gynecology and Obstetrics stage 4 at diagnosis. All patients underwent surgery after 6 courses of neoadjuvant chemotherapy with carboplatin, paclitaxel, and bevacizumab. The median number of bevacizumab injections was 3 (3–4), and the median time between the last injection of bevacizumab and surgery was 54 days (34–110 days). One patient had a grade 3 complication (lymphocyst with puncture under computed tomographic scans).ConclusionIn this preliminary study, debulking surgery after neoadjuvant chemotherapy that included bevacizumab did not increase the rate of postoperative complications when there was a reasonable interval between the last bevacizumab injection and surgery. Larger studies are warranted to assess surgical safety after antiangiogenic treatment in the neoadjuvant setting for advanced ovarian cancer.

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Role of Lymphadenectomy During Interval Debulking Surgery Performed After Neoadjuvant Chemotherapy in Patients With Advanced Ovarian Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.646135 ◽

2021 ◽

Vol 11 ◽

Author(s):

Minjun He ◽

Yuerong Lai ◽

Hongyu Peng ◽

Chongjie Tong

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Residual Disease ◽

Advanced Ovarian Cancer ◽

Progression Free Survival ◽

Debulking Surgery ◽

Hazard Ratios ◽

Significant Difference ◽

Interval Debulking Surgery

ObjectiveThe role of lymphadenectomy in interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer remains unclear. We aimed to investigate the clinical significance of lymphadenectomy in IDS.MethodsWe retrospectively reviewed and analyzed the data of patients with advanced ovarian cancer who underwent NACT followed by IDS.ResultsIn 303 patients receiving NACT-IDS, lymphadenectomy was performed in 127 (41.9%) patients. One hundred and sixty-three (53.8%) patients achieved no gross residual disease (NGRD), and 69 (22.8%) had residual disease < 1 cm, whereas 71 (23.4%) had residual disease ≥ 1cm. No significant difference in progression-free survival (PFS) and overall survival (OS) was observed between the lymphadenectomy group and the no lymphadenectomy group in patients with NGRD, residual disease < 1 cm, and residual disease ≥ 1 cm, respectively. The proportions of pelvic, para-aortic and distant lymph node recurrence were 7.9% (10/127), 4.7% (6/127) and 5.5% (7/127) in the lymphadenectomy group, compared with 5.7% (10/176, P = 0.448), 4.5% (8/176, P = 0.942) and 5.1% (9/176, P = 0.878), respectively, in no lymphadenectomy group. Multivariate analysis identified residual disease ≥ 1 cm [hazard ratios (HR), 4.094; P = 0.008] and elevated CA125 levels after 3 cycles of adjuvant chemotherapy (HR, 2.883; P = 0.004) were negative predictors for OS.ConclusionLymphadenectomy may have no therapeutic value in patients with advanced ovarian cancer underwent NACT-IDS. Our findings may help to better the therapeutic strategy for advanced ovarian cancer. More clinical trials are warranted to further clarify the real role of lymphadenectomy in IDS.

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Primary Surgery or Neoadjuvant Chemotherapy in Advanced Ovarian Cancer: The Debate Continues…

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_160624 ◽

2016 ◽

pp. 153-162 ◽

Cited By ~ 2

Author(s):

Renee Cowan ◽

Dennis Chi ◽

Sean Kehoe ◽

Matthew Nankivell ◽

Alexandra Leary

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Residual Disease ◽

Tumor Biology ◽

Advanced Ovarian Cancer ◽

Debulking Surgery ◽

Primary Debulking Surgery ◽

Platinum Based Chemotherapy ◽

Patient Reported ◽

The Impact

Primary debulking surgery (PDS) followed by platinum-based chemotherapy has been the cornerstone of treatment for advanced ovarian cancer for decades. Primary debulking surgery has been repeatedly identified as one of the key factors in improving survival in patients with advanced ovarian cancer, especially when minimal or no residual disease is left behind. Achieving these results sometimes requires extensive abdominal and pelvic surgical procedures and consultation with other surgical teams. Some clinicians who propose a primary chemotherapy approach reported an increased likelihood of leaving no macroscopic disease after surgery and improved patient-reported outcomes and quality-of-life (QOL) measures. Given the ongoing debate regarding the relative benefit of PDS versus neoadjuvant chemotherapy (NACT), tumor biology may aid in patient selection for each approach. Neoadjuvant chemotherapy offers the opportunity for in vivo chemosensitivity testing. Studies are needed to determine the best way to evaluate the impact of NACT in each individual patient with advanced ovarian cancer. Indeed, the biggest utility of NACT may be in research, where this approach provides the opportunity for the investigation of predictive markers, mechanisms of resistance, and a forum to test novel therapies.

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CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer

Journal of Gynecologic Oncology ◽

10.3802/jgo.2013.24.2.141 ◽

2013 ◽

Vol 24 (2) ◽

pp. 141 ◽

Cited By ~ 21

Author(s):

Naoto Furukawa ◽

Yoshikazu Sasaki ◽

Aiko Shigemitsu ◽

Juria Akasaka ◽

Seiji Kanayama ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Ovarian Cancer ◽

Ca 125 ◽

Debulking Surgery ◽

Interval Debulking Surgery

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Comparison of Platinum-based Neoadjuvant Chemotherapy and Primary Debulking Surgery in Patients with Advanced Ovarian Cancer

The Journal of Obstetrics and Gynecology of India ◽

10.1007/s13224-013-0425-z ◽

2013 ◽

Vol 63 (6) ◽

pp. 405-409 ◽

Cited By ~ 4

Author(s):

Manizheh Sayyah-Melli ◽

Gita Kashi Zonoozi ◽

Shahryar Hashemzadeh ◽

Ali Esfahani ◽

Elaheh Ouladehsahebmadarek ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Ovarian Cancer ◽

Debulking Surgery ◽

Primary Debulking Surgery

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Clinical significance of primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery in advanced ovarian cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa015 ◽

2020 ◽

Vol 50 (4) ◽

pp. 379-386

Author(s):

Shin Nishio ◽

Kimio Ushijima

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Clinical Significance ◽

Performance Status ◽

Advanced Ovarian Cancer ◽

Stage Iii ◽

Current Evidence ◽

Debulking Surgery ◽

Primary Debulking Surgery ◽

Interval Debulking Surgery

Abstract Primary debulking surgery followed by platinum-based chemotherapy remains the standard treatment of patients with stage III–IV epithelial ovarian cancer. Neoadjuvant chemotherapy is an alternative treatment regimen that can be considered in selected patients. Complete cytoreduction, both through primary debulking surgery and interval debulking surgery, has a major positive effect on survival and should be the goal, even if this requires extensive surgery. When thorough assessment of tumor spread and performance status of the patient indicates that complete primary cytoreduction is not feasible without unacceptable morbidity, then alternative therapeutic strategies, such as neoadjuvant chemotherapy, must be considered. Such patients can be offered the option of interval debulking surgery after checking their response to neoadjuvant chemotherapy and resolution of the initial obstacles for primary debulking surgery (i.e. complete response of irresectable disease and improvement of the performance status). Current evidence suggests that a selected group of patients with International Federation of Gynecology and Obstetrics stage III–IV ovarian cancer will benefit from NAC-IDS. Research is ongoing to identify patients who might derive the greatest benefit from neoadjuvant chemotherapy followed by interval debulking surgery, instead of primary debulking surgery, on the basis of radiological, genetic, pathological, and immunological variables. In this review, we discuss current knowledge about the clinical significance of primary debulking surgery and neoadjuvant chemotherapy in advanced ovarian cancer and discuss unanswered questions in the field.

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