Management of advanced staged ovarian cancer in a national cancer center: comparison of the efficacy of primary debulking surgery versus neoadjuvant chemotherapy

Background: In most cases, ovarian cancer is diagnosed at an advanced stage. The aim of this study was to determine if primary debulking surgery (PDS) for women with advanced epithelial ovarian cancer is an equivalent treatment approach to neoadjuvant chemotherapy (NACT). Methods: A retrospective analysis of 214 women with stage FIGO IIIC and IV ovarian cancer was performed at the Institute of Oncology Ljubljana, Slovenia. Women were divided into two groups based on their primary treatment. The first group was the NACT group (184 women) and the second the PDS group (30 women). The selection of the women for PDS or NACT was based on the expertise of the gynecological-oncological surgeon and the image exam results. We used the Kaplan-Meier method for calculating overall survival (OS) and progression-free survival (PFS). The statistical analysis was performed with IBM SPSS. Results: The median OS was lower in the NACT group than in the PDS group, 25 months (95% CI 20.6-29.5) and 46 months (95% CI 32.9-62.1), respectively. The PFS in the NACT group was 8 months (95% CI 6.4-9.5) and 18 months (95% CI 12.5-23.4) in the PDS group. For women treated with PDS the 5-year survival rate was 36.7% and 20.1% in the NACT group. Conclusion: In this study the best survival results were observed in women treated with PDS, followed by adjuvant chemotherapy. If a woman is not suitable for surgery, NACT doubles the chance of a complete gross resection. Despite higher rates of complete gross resection after NACT, women treated with PDS (complete gross resection or optimal surgery) had higher OS.

Download Full-text

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

Journal of Ovarian Research ◽

10.1186/s13048-019-0562-9 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 3

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.

Download Full-text

Prognostic Value of Serum HE4 Levels and Risk of Ovarian Malignancy Algorithm Scores at the Time of Ovarian Cancer Diagnosis

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000181 ◽

2014 ◽

Vol 24 (7) ◽

pp. 1173-1180 ◽

Cited By ~ 15

Author(s):

Jeroen Kaijser ◽

Vanya Van Belle ◽

Toon Van Gorp ◽

Ahmad Sayasneh ◽

Ignace Vergote ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Cox Regression ◽

Evaluation Criteria ◽

Progression Free Survival ◽

Primary Treatment ◽

University Hospital ◽

Ovarian Malignancy ◽

Debulking Surgery ◽

Primary Debulking Surgery

ObjectivesThe aim of this study is to assess whether the pretreatment serum HE4 levels or the Risk of Ovarian Malignancy Algorithm (ROMA) scores at the time of initial diagnosis are associated with progression-free survival (PFS) and disease-specific survival (DSS) in patients with ovarian cancer receiving either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery.MethodsA survival analysis of 101 cases of invasive ovarian cancer recruited in a previous diagnostic accuracy study was conducted from 2005 to 2009 at the University Hospital KU Leuven, Belgium. Serum HE4 levels (pM) and ROMA scores (%) were obtained before primary treatment. Dates of death were obtained by record linkage with patient hospital files. Progression was evaluated according to the Response Evaluation Criteria in Solid Tumors. Adjusted hazards ratios (HRs) were estimated using multivariable Cox regression.ResultsEighty patients (79%) with invasive ovarian cancer underwent primary debulking surgery, whereas 21 (21%) received neoadjuvant chemotherapy. The median DSS was 3.72 years (95% confidence interval [CI], 3.19–4.07). Fifty-two patients (51%) died of disease, and 74 patients (73%) had progressive disease during follow-up. On univariable analysis, elevated pretreatment HE4 levels and ROMA scores were related to worse prognosis. However, after the adjustment for classic prognostic variables, HE4 levels (log2-transformed) and ROMA scores were unrelated to DSS (log-2 HE4: adjusted HR, 1.01; 95% CI, 0.84–1.21 and ROMA: adjusted HR per 10% increase, 0.96; 95% CI, 0.84–1.12) and PFS (log-2 HE4: adjusted HR, 0.98; 95% CI, 0.84–1.13 and ROMA: adjusted HR per 10% increase, 0.98; 95% CI, 0.88–1.11).ConclusionsPretreatment HE4 levels and ROMA scores are not independent prognostic factors for DSS and PFS after multivariable adjustment in patients with ovarian cancer.

Download Full-text

Advanced stage ovarian cancer patients with neoadjuvant chemotherapy suffered worse recurrence free survival

10.21203/rs.2.20542/v1 ◽

2020 ◽

Author(s):

Cailiang Wu ◽

Xuexin Zhou ◽

Yiwen Feng ◽

Yi Miao ◽

Ye Yang ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Recurrence Free Survival ◽

Advanced Stage ◽

Debulking Surgery ◽

Fallopian Tube Cancer ◽

Free Survival ◽

Primary Peritoneal Cancer ◽

Peritoneal Cancer ◽

Primary Debulking Surgery

Abstract Background Neoadjuvant chemotherapy (NACT) has been applied for the treatment of patients with advanced-stage epithelial ovarian cancer (EOC), fallopian tube cancer, and primary peritoneal cancer, as these patients have a low likelihood of achieving optimal debulking and are thus poor surgical candidates. Herein, we explore the effects of NACT and compare the surgical outcomes and recurrence data in patients who receive interval debulking surgery followed NACT(NACT-IDS) or primary debulking surgery(PDS). Methods A retrospective, single-center, observational study was conducted. Patients with advanced-stage EOC, fallopian tube cancer and primary peritoneal cancer who were treated with NACT or primary debulking surgery were enrolled. The effects of NACT as well as the surgical outcomes and recurrence data were compared between the NACT-IDS and PDS groups. Results The albumin level was elevated (42.61±3.46 g/L vs. 37.47±5.42 g/L, P=0.001) and the levels of CA12-5 and HE4 significantly decreased (P=0.002, 0.003) in patients after neoadjuvant courses. The operation time, amount of blood loss during surgery, rate of bowel resection, time to chemotherapy, and platinum-free interval were comparable between the two groups (P＞0.05). Recurrence-free survival was worse in the NACT-IDS group than in the PDS group (HR=2.406, 95% CI[1.024, 5.657]). Conclusion NACT improved the condition of advanced-stage patients, but a poor recurrence free survival rate was observed; thus, NACT should not be applied in non-selected patients.

Download Full-text

Delays from neoadjuvant chemotherapy to interval debulking surgery and survival in ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000989 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1554-1561

Author(s):

Ying L Liu ◽

Qin C Zhou ◽

Alexia Iasonos ◽

Olga T Filippova ◽

Dennis S Chi ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Rank Test ◽

Debulking Surgery ◽

Free Survival ◽

Interval Debulking Surgery ◽

The Impact

IntroductionDelays from primary surgery to chemotherapy are associated with worse survival in ovarian cancer, however the impact of delays from neoadjuvant chemotherapy to interval debulking surgery is unknown. We sought to evaluate the association of delays from neoadjuvant chemotherapy to interval debulking with survival.MethodsPatients with a diagnosis of stage III/IV ovarian cancer receiving neoadjuvant chemotherapy from July 2015 to December 2017 were included in our analysis. Delays from neoadjuvant chemotherapy to interval debulking were defined as time from last preoperative carboplatin to interval debulking >6 weeks. Fisher’s exact/Wilcoxon rank sum tests were used to compare clinical characteristics. The Kaplan–Meier method, log-rank test, and multivariate Cox Proportional-Hazards models were used to estimate progression-free and overall survival and examine differences by delay groups, adjusting for covariates.ResultsOf the 224 women, 159 (71%) underwent interval debulking and 34 (21%) of these experienced delays from neoadjuvant chemotherapy to interval debulking. These women were older (median 68 vs 65 years, P=0.05) and received more preoperative chemotherapy cycles (median 6 vs 4, P=0.003). Delays from neoadjuvant chemotherapy to interval debulking were associated with worse overall survival (HR 2.4 95% CI 1.2 to 4.8, P=0.01), however survival was not significantly shortened after adjusting for age, stage, and complete gross resection, HR 1.66 95% CI 0.8 to 3.4, P=0.17. Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse progression-free survival (HR 1.55 95% CI 0.97 to 2.5, P=0.062). Increase in number of preoperative cycles (P=0.005) and lack of complete gross resection (P<0.001) were the only variables predictive of worse progression-free survival.DiscussionDelays from neoadjuvant chemotherapy to interval debulking were not associated with worse overall survival after adjustment for age, stage, and complete gross resection.

Download Full-text

Therapeutic value of selective lymphadenectomy in interval debulking surgery for stage IIIc and IV epithelial ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000200 ◽

2019 ◽

Vol 29 (4) ◽

pp. 761-767 ◽

Cited By ~ 3

Author(s):

Nan Song ◽

Yunong Gao

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Progression Free Survival ◽

Debulking Surgery ◽

Stage Iiic ◽

Free Survival ◽

Systematic Lymphadenectomy ◽

Interval Debulking Surgery ◽

Selective Lymphadenectomy ◽

Cox Analysis

ObjectiveThe role of selective lymphadenectomy at the time of interval debulking surgery in patients with advanced ovarian cancer remains a topic of debate. This study aimed to evaluate the value of selective lymphadenectomy during interval debulking surgery in patients with radiologic evidence of lymph node metastasis at initial diagnosis that ultimately become negative on imaging after neoadjuvant chemotherapy.MethodsA retrospective analysis including patients with stage IIIC–IV epithelial ovarian cancer and suspicious pelvic or para-aortic lymph node metastasis by imaging at diagnosis that resolved after neoadjuvant chemotherapy. The study was conducted from January 1996 to June 2016 with R0 interval debulking surgery. The patients with disease progression after neoadjuvant chemotherapy were excluded. Suspicious metastatic lymph nodes at initial diagnosis by computed tomography/magnetic resonance imaging were excised by selective lymphadenectomy. Survival curves were constructed by the Kaplan-Meier method, and a multivariate analysis was performed using Cox regression.ResultsThere were a total of 330 patients included in the analysis. Selective lymphadenectomy of suspicious nodes (Group 1) was performed in 145 patients. Systematic lymphadenectomy (Group 2) was performed in 118 patients. Sixty-seven patients did not undergo lymphadenectomy (Group 3). There were no significant differences in clinicopathologic features among the groups. Median progression-free survival was 28, 30.5, and 22 months in Groups 1, 2, and 3, respectively (log-rank, p=0.049). No-lymphadenectomy was an independent factor affecting progression-free survival (Cox analysis, HR=1.729, 95% CI 1.213 to 2.464, p=0.002), with no difference between Groups 1 and 2 (Cox analysis, HR=1.097, 95% CI 0.815 to 1.478, p=0.541). Median overall survival was 50, 59, and 57 months in Groups 1, 2, and 3, respectively (Cox analysis, p=0.566). Patients who underwent selective lymphadenectomy had lower 1-year frequencies of lower extremity lymphedema and lymphocysts than those with systematic lymphadenectomy (6.2% vs 33.1%, p<0.001, and 6.2 % vs 27.1%, p<0.001, respectively).ConclusionsExtent of lymphadenectomy (systematic or selective) had no significant impact on progression-free survival or overall survival. In addition, the risks of lower extremity lymphedema and lymphocysts were lower in patients who underwent selective lymphadenectomy.

Download Full-text

Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850)

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001640 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1657-1664 ◽

Cited By ~ 4

Author(s):

Anna Fagotti ◽

Maria Gabriella Ferrandina ◽

Giuseppe Vizzielli ◽

Tina Pasciuto ◽

Francesco Fanfani ◽

...

Keyword(s):

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Progression Free Survival ◽

Debulking Surgery ◽

Free Survival ◽

Primary Peritoneal Cancer ◽

Peritoneal Cancer ◽

Primary Debulking Surgery ◽

Interval Debulking Surgery ◽

Tumor Load

ObjectiveTo investigate whether neoadjuvant chemotherapy followed by interval debulking surgery is superior to primary debulking surgery in terms of perioperative complications and progression-free survival, in advanced epithelial ovarian, fallopian tube or primary peritoneal cancer patients with high tumor load.MethodsPatients with advanced epithelial ovarian, fallopian tube or primary peritoneal cancer (stage IIIC-IV) underwent laparoscopy. Patients with high tumor load assessed by a standardized laparoscopic predictive index were randomly assigned (1:1 ratio) to undergo either primary debulking surgery followed by adjuvant chemotherapy (arm A), or neoadjuvant chemotherapy followed by interval debulking surgery and adjuvant chemotherapy (arm B). Co-primary outcome measures were progression-free survival and post-operative complications; secondary outcomes were overall survival, and quality of life. Survival analyses were performed on an intention-to-treat population.Results171 patients were randomly assigned to primary debulking surgery (n=84) versus neoadjuvant chemotherapy (n=87). Rates of complete resection (R0) were different between the arms (47.6% in arm A vs 77.0% in arm B; p=0.001). 53 major postoperative complications were registered, mainly distributed in arm A compared with arm B (25.9% vs 7.6%; p=0.0001). All patients were included in the intent-to-treat analysis. With an overall median follow-up of 59 months (95% CI 53 to 64), 142 (83.0%) disease progressions/recurrences and 103 deaths (60.2%) occurred. Median progression-free and overall survival were 15 and 41 months for patients assigned to primary debulking surgery, compared with 14 and 43 months for patients assigned to neoadjuvant chemotherapy, respectively (HR 1.05, 95% CI 0.77 to 1.44, p=0.73; HR 1.12, 95% CI 0.76 to 1.65, p=0.56).ConclusionsNeoadjuvant chemotherapy and primary debulking surgery have the same efficacy when used at their maximal possibilities, but the toxicity profile is different.

Download Full-text