Does aggressive primary debulking surgery influence survival in ovarian cancer?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5561-5561
Author(s):  
Yakir Segev ◽  
Barry Rosen ◽  
Joan Murphy ◽  
Stephane Laframboise ◽  
Jason Esli Dodge ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Medical Records ◽  
Bowel Resection ◽  
Residual Disease ◽  
Debulking Surgery ◽  
Stage Iiic ◽  
Primary Debulking Surgery ◽  
Limited Surgery ◽  
Extent Of Surgery ◽  
Pelvic Peritonectomy

5561 Background: Evidence comparing outcomes in patients receiving primary debulking surgery (PDS) to those receiving neoadjuvant chemotherapy (NACT) for advanced stage ovarian carcinoma is conflicting. We conducted a retrospective survival analysis of all patients with stage IIIC and IV serous ovarian cancer treated at our institute by either PDS or NACT. Methods: Data was extracted from patient synoptic OR reports and medical records between January 2003 and December 2011. Survival comparisons between patients receiving NACT and PDS were made according to aggressiveness of surgery and residual disease following surgery. Aggressive surgery was defined by one of the following procedures; pelvic peritonectomy, any bowel resection, diaphragm resection, diaphragm peritonectomy and splenectomy. Results: Out of 342 patients, 143 (41%) had NACT and 199 (59%) had PDS. Patients undergoing PDS had a median survival (MS) of 58 months compared to 34 months for NACT. Patients undergoing PDS with > 10mm and <10mm residual disease, had a MS of 33 and 55 months, respectively; whereas those with microscopic disease have not yet reached their MS. In the NACT group, MS for < and > 10 mm residual disease was 30 months for both, compared with 39 months for those with microscopic disease. Within the PDS group, those undergoing limited surgery had a MS of 48 months whereas MS has not been reached for those undergoing aggressive surgery. Over 60% of patients undergoing PDS with microscopic residual were alive at 7 years. In the NACT group, there was no difference in survival according to extent of surgery. Conclusions: Patients withPDS, whether debulked to < 10mm or to microscopic disease have a significant and lengthy survival advantage over patients receiving NACT.

Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients not candidates for optimal primary surgery: Safety and effectivenes.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5540-5540
Author(s):  
Vanessa Costa Miranda ◽  
Angelo Bezerra de Sousa Fede ◽  
Carlos Henrique Dos Anjos ◽  
Juliana Ribeiro da Silva ◽  
Fernando Barbosa Sanchez ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Disease Progression ◽  
Advanced Ovarian Cancer ◽  
Length Of Hospital Stay ◽  
Complete Response ◽  
Debulking Surgery ◽  
Stage Iiic ◽  
Primary Debulking Surgery

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.

Recurrence patterns in patients with abnormal cardiophrenic lymph nodes at ovarian cancer diagnosis

2020 ◽  
Vol 30 (4) ◽  
pp. 504-508 ◽  
Author(s):  
Alyssa Larish ◽  
Ismail Mert ◽  
Michaela McGree ◽  
Amy Weaver ◽  
Shannon Sheedy ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Lymph Nodes ◽  
Ct Scan ◽  
Residual Disease ◽  
Assessment Scale ◽  
Qualitative Assessment ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Response To Chemotherapy ◽  
Increased Risk

ObjectivesMetastases in cardiophrenic lymph nodes noted at diagnosis of epithelial ovarian cancer confer a poor prognosis. It is unclear if cardiophrenic nodal metastases portend an atypical pattern of recurrence. We report on patients with radiographically involved cardiophrenic lymph nodes who underwent optimal primary debulking surgery to describe patterns of recurrence and response to chemotherapy.MethodsPatients undergoing primary debulking surgery for stage IIIC/IV epithelial ovarian carcinoma with residual disease ≤1.0 cm at our institution from 2003 to 2011 with a pre-operative computed tomography (CT) scan were identified. Scans were reviewed by blinded radiologists, who identified abnormal cardiophrenic lymph nodes via a qualitative assessment scale based on size, heterogeneity, and architecture.ResultsOf the 250 patients identified, a recurrence site was documented in 22/27 (81.5%) with abnormal pre-operative cardiophrenic lymph nodes (defined by an elevated Qualitative Assessment Scale (QAS) score of ≥4), and in 128/223 (57.4%) without abnormal pre-operative cardiophrenic lymph nodes. Median short axis and long axis lymph node diameters for these patients was 9 (range 6–15) mm and 15 (range 11–22) mm, respectively. Cardiophrenic lymph nodes were resected in one patient. Patients with abnormal cardiophrenic nodes are more likely to have synchronous recurrence in thorax/pelvis and abdomen (50.0% (11/22) vs 25.0% (32/128), p=0.02) and less likely to have isolated recurrence in pelvis or abdomen (40.9% (9/22) vs 68.0% (87/128)). All patients who had a CT scan after six cycles of chemotherapy had improvement (defined as reduction of QAS score) in cardiophrenic lymphadenopathy.ConclusionsDespite cardiophrenic adenopathy demonstrating a complete radiographic response to chemotherapy, their presence pre-operatively is associated with an increased risk of recurrence in the thorax. Knowledge of this propensity to recur in the thorax is important to ensure all extra-abdominal recurrence sites are diagnosed and managed appropriately.

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

2016 ◽  
pp. 153-162 ◽  
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.

Prognostic impact of histological response after neoadjuvant chemotherapy in patients with stage IIIC/IV ovarian cancer undergoing complete cytoreductive surgery at the time of interval debulking surgery

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16032-16032
Author(s):  
P. Morice ◽  
J. Ferron ◽  
A. Rey ◽  
Y. Zafrani ◽  
C. Uzan ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Prognostic Impact ◽  
Histological Response ◽  
Inclusion Criteria ◽  
Debulking Surgery ◽  
Stage Iiic ◽  
Initial Surgery ◽  
Interval Debulking Surgery ◽  
Group 1

16032 Background: The aim of this study was to evaluate the prognostic impact of histological response at the time of interval debulking surgery (IDS) in patients treated with neoadjuvant chemotherapy (NACT) for unresectable advanced-stage ovarian cancer (ASOC). Methods: A retrospective study was conducted in our institution to select cases fulfilling 3 following inclusion criteria: 1. Patients with unresectable (evaluated in most of them with initial surgery + biopsies) ASOC. All patients had residual disease > 2 cm after such initial surgery; 2. At least 3 courses of platinum + paclitaxel NACT; 3. Patients undergoing after NACT an IDS with absence of macroscopic residual disease at the end of the debulking surgery. IDS was followed by post-operative chemotherapy. Patients were classified into 3 groups according to the histological response (in the peritoneum & nodes) after NACT: group 1: no residual disease in peritoneum; group 2: persistent residual disease but with histological signs of chemoactivity (marked histological changes) and group 3: persistence of at least 1 site with no changes in the tumor (persistence of very active cells). Survival was compared between these 3 groups. Results: Fifty-eight patients treated between 1997 and 2004 fulfilled inclusion criteria (49 had stage IIIC and 9 stage IV disease). Respectively 47 & 11 patients received 3–4 or 5–6 courses of chemotherapy before IDS. Respectively 11, 11 and 36 patients were in groups 1, 2 & 3. The median time of follow-up was 41 months. Three-year overall survival in groups 1, 2 & 3 was respectively: 81%, 39% and 62% (no statistical difference). Three- year event-free survival in groups 1, 2 & 3 was respectively: 46%, 18% and 19% (p=.04 between group 1 versus 2+3). Conclusions: These results suggest that the degree of histological response have a limited impact on the survival of patients when complete debulking surgery is achieved at IDS. The degree of tumor cell viability after initial chemotherapy is not a reliable marker for modifying chemotherapy after debulking surgery in such patients. No significant financial relationships to disclose.

Primary debulking surgery (PDS) for stage IIIc ovarian cancer: Quo vadis?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15568-e15568
Author(s):  
Leslie A. Garrett ◽  
Whitfield Board Growdon ◽  
David M. Boruta ◽  
Marcela G del Carmen ◽  
Anna M. Priebe ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Tumor Biology ◽  
Advanced Ovarian Cancer ◽  
High Volume ◽  
Tumor Board ◽  
Debulking Surgery ◽  
Stage Iiic ◽  
En Bloc ◽  
Quo Vadis

e15568 Background: The efficacy of PDS for advanced ovarian cancer has recently been challenged by data suggesting equivalent clinical outcomes for neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS). The strongest known predictor of prolonged survival in either group is the ability to achieve complete resection (CR) to no residual disease. PDS that results in a CR is associated with the longest overall survival of any sequence of treatment. The aim of this study was to determine what type of surgical approach is required to successfully perform PDS. Methods: All women with newly diagnosed stage IIIC epithelial ovarian carcinoma treated at our institution from 2000 to 2010 were identified. Pathology was prospectively reviewed by a faculty gynecologic pathologist. Treatment planning was discussed and documented at our weekly multidisciplinary tumor board conference. Data was retrospectively extracted from computerized medical records. Results: 344 (86%) of 401 women underwent PDS. Optimal debulking was achieved in 278 patients (81%): 35% had CR while 46% had 0.1-1.0 cm residual disease. 56 stage IIIC pts (19%) had a suboptimal surgical outcome with ≥ 1.0 cm. Compared to those having a CR, patients with 0.1-1.0 cm residual were more likely to require splenectomy (17 v 5%; P = 0.002) and transverse colectomy (19 v 10%; P = 0.042), with comparable rates of rectosigmoid resection (41 v 39%; P = 0.712) and en bloc pelvic resection including total peritonectomy (26 v 30%; P = 0.050). Patients undergoing CR were more likely to have diaphragmatic surgery (31 v 20; P = 0.068) and lymphadenectomy (67 v 33%; P < 0.001). Conclusions: PDS is the preferred treatment of stage IIIC epithelial ovarian cancer at high-volume centers demonstrating >75% rates of optimal cytoreduction. Tumor biology may lead to the need for more aggressive upper abdominal procedures in patients with 0.1-1.0 residual. Diaphragm resection, stripping or ablation is more often required in order to achieve CR. Since subclinical macroscopic nodal metastases are often present, lymphadenectomy is also frequently performed to ensure that all possible disease has been resected.

scholarly journals Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Yan Gao ◽  
Yuan Li ◽  
Chunyu Zhang ◽  
Jinsong Han ◽  
Huamao Liang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Survival Curve ◽  
Progression Free Survival ◽  
Debulking Surgery ◽  
Stage Iiic ◽  
Free Survival ◽  
Primary Debulking Surgery ◽  
Interval Debulking Surgery

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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