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

2013 ◽  
Vol 24 (2) ◽  
pp. 141 ◽  
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

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

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.

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

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.

Does the Number of Neoadjuvant Chemotherapy Cycles before Interval Debulking Surgery Influence Survival in Advanced Ovarian Cancer?

Oncology ◽  
2016 ◽  
Vol 91 (6) ◽  
pp. 331-340 ◽  
Author(s):  
Cherif Akladios ◽  
Jean-Jacques Baldauf ◽  
Frederic Marchal ◽  
Michel Hummel ◽  
Laure-Emilie Rebstock ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Ovarian Cancer ◽  
Debulking Surgery ◽  
Interval Debulking Surgery

scholarly journals The Outcomes of Primary Debulking Surgery and Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

2016 ◽  
pp. 111
Author(s):  
Dino Rinaldy ◽  
Andrijono Andrijono ◽  
Bambang Sutrisna
Keyword(s):  
Ovarian Cancer ◽  
Survival Rate ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Ovarian Cancer ◽  
Mean Value ◽  
Ca 125 ◽  
Perioperative Outcomes ◽  
Debulking Surgery ◽  
Chemotherapy Group ◽  
Primary Debulking Surgery

Objective: To compare the outcomes and survival rate of primary debulking surgery with neoadjuvant chemotherapy. Method: We selected advanced ovarian cancer patients from medical records. Subjects were allocated into groups of primary debulking surgery and neoajuvant chemotherapy by considering the inclusion and exclusion criteria. We analyzed the data using T test, Fisher’s exact, and chi-square. The survival rate was presented in Kaplan Meier curve, whereas the significance was tested with Logrank. We managed the data using STRATA software version 12. Result: We obtained 32 cases of primary debulking surgery group and 20 cases of the neoadjuvant chemotherapy group. Most of the subjects (44.2%) were 40-49 years old and 80.8% had delivered more than twice. The mean value of Ca-125 at admission was 3,594.8 u/ml (range 66.6 to 73,000 u/ml). Total of 31 subjects showed the serous histologic type (59.6%). There was no association between primary debulking surgery and neoadjuvant chemotherapy for the parameter of operative time, blood loss, organs injury, ICU stay, and hospital stay (p>0.05). Primary debulking surgery had a survival rate similar to neoadjuvant chemotherapy group (p=0.95). Conclusion: The perioperative outcomes of advanced ovarian cancer patients has similar result between primary debulking surgery and neoadjuvant chemotherapy. Primary debulking surgery has a survival rate similar to neoadjuvant chemotherapy group. [Indones J Obstet Gynecol 2016; 4-2: 111-115] Keywords: advanced ovarian cancer, neoadjuvant chemotherapy, primary debulking surgery

Dose-Dense Chemotherapy and Neoadjuvant Chemotherapy for Ovarian Cancer

2012 ◽  
pp. 349-354
Author(s):  
Keiichi Fujiwara ◽  
Noriyuki Katsumata ◽  
Takashi Onda
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Standard Procedure ◽  
Gynecologic Oncology ◽  
Advanced Ovarian Cancer ◽  
Breast Conserving Surgery ◽  
Gynecologic Oncology Group ◽  
Debulking Surgery ◽  
Interval Debulking Surgery ◽  
Dose Dense

Overview: Two of the innovative chemotherapeutic approaches to ovarian cancer treatment, dose-dense chemotherapy and neoadjuvant chemotherapy, will be discussed herein. The primary concept of dose-dense chemotherapy is to administer the same cumulative dose of chemotherapy over a shorter period. Increased dose density is achieved by reducing the interval between each dose of chemotherapy. The Japanese Gynecologic Oncology Group (JGOG) first demonstrated the survival advantage of dose-dense weekly administration of paclitaxel in 2009. However, there are unanswered questions, such as the question of dose-dense carboplatin versus less dose-intensive regimens. Clear cell or mucinous carcinomas seem to need other strategies, such as targeted agents. The aim of neoadjuvant chemotherapy is to reduce tumor volume or spread before main treatment. This could then make the main procedures easier or less invasive, just like breast-conserving surgery after neoadjuvant chemotherapy. In advanced ovarian cancer, standard procedure is maximum primary debulking surgery followed by chemotherapy. Recently, a prospective randomized trial demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to the standard procedure. However, there are several questions that remain unanswered, such as the suitable number of chemotherapy cycles before interval debulking surgery. Some of those questions regarding dose-dense chemotherapy or neoadjuvant chemotherapy may be resolved by ongoing or future prospective trials.

Neoadjuvant chemotherapy versus primary debulking surgery in advanced ovarian cancer: Experience in Mexican population.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15567-e15567
Author(s):  
Abdel Karim Dip Borunda ◽  
Eucario Leon Rodriguez ◽  
Alejandra Armengol Alonso
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Prospective Trial ◽  
Advanced Ovarian Cancer ◽  
Ca 125 ◽  
Debulking Surgery ◽  
Histologic Subtype ◽  
Primary Debulking Surgery ◽  
Survival Difference ◽  
Significant Survival

e15567 Background: Primary debulking surgery is considered the standard of treatment in advanced ovarian cancer (AOC) while neoadjuvant chemotherapy is used in non resectable stages. Methods: We retrospectively analyzed 68 AOC cases from January 2000 to December 2011. 35 received neoadjuvant chemotherapy (NAC) while 33 were resected primarily and received adjuvant chemotherapy (AC). To compare both groups we used T standard test and 2 sided chi -squared. Non parametric variables were analyzed with U Mann – Whitney. Overall survival(OS) was analyzed using Kaplan Meier method with log rank test. We considered statistically significant p<0.05. (SPSS v 17). Results: The median age was 60 (NAC) vs 53(AC) years respectively. The NAC group had more advanced stage disease (FIGO IIIC/IV stage; 71/29% vs 91/9%; p=0.04). The most frequent histologic subtype in both groups was serous - papillary and histologic grade was poorly differentiated in 71 vs 72% (p=0.41). At diagnosis the median levels of ca-125 were 1,896 U/ml for NAC group vs 768 U/ml for AC group (p=0.025). After the primary treatment received the median levels of ca – 125 were 29 U/ml vs 84 U/ml (p=0.76). Platin based chemotherapy was used in 95% vs 70% respectively. Complete resection of macroscopic disease was observed in 68% of NAC vs 63% in AC respectively. No statistical differences were observed in surgical time (median 192 min vs 204 min; p=0.55) and surgical bleeding (468 vs 510ml; p=0.79). Median survival time was 23 +/-26 months for neoadjuvant and 27+/- 35 months for primary surgery (p=0.56). In a subgroup analysis of patients who received 6 neoadjuvant cycles vs perioperatory chemotherapy (3 pre and 3 postoperatory) we observed a significant survival difference, with a median of 62 months (95% CI 12-38) vs 12 months (95% CI 54 – 178) respectively (p=0.010). Conclusions: Non inferior survival or differences in surgical outcomes were observed with neoadjuvant therapy. Significant survival increase was observed in patients who received complete chemotherapy schedule before surgery, this evidence allowed to design a prospective trial in our Institution.

Phase II Feasibility Study of Sequential Couplets of Cisplatin/Topotecan Followed by Paclitaxel/Cisplatin as Primary Treatment for Advanced Epithelial Ovarian Cancer: A National Cancer Institute of Canada Clinical Trials Group Study

2000 ◽  
Vol 18 (24) ◽  
pp. 4038-4044 ◽  
Author(s):  
P. Hoskins ◽  
E. Eisenhauer ◽  
I. Vergote ◽  
J. Dubuc-Lissoir ◽  
B. Fisher ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Randomized Study ◽  
Advanced Ovarian Cancer ◽  
Primary Treatment ◽  
Ca 125 ◽  
Debulking Surgery ◽  
Primary Surgery ◽  
Nonhematologic Toxicity ◽  
Interval Debulking Surgery ◽  
Optimal Debulking

PURPOSE: Despite the improved results in advanced ovarian cancer achieved with the addition of paclitaxel to frontline therapy, there remains room for improvement. One approach is to add new agents such as topotecan. Because myelosuppression limits the delivery of topotecan with paclitaxel/cisplatin in a three-drug combination, we explored giving sequential couplets of cisplatin/topotecan followed by paclitaxel/cisplatin. PATIENTS AND METHODS: Forty-four patients with residual epithelial ovarian carcinoma after primary surgery were studied. Cisplatin 50 mg/m2 on day 1 and topotecan 0.75 mg/m2 on days 1 through 5 were administered at 21-day intervals for four cycles, followed by interval debulking surgery (if optimal debulking was not achieved with primary surgery), and then paclitaxel 135 mg/m2 over 24 hours on day 1 and cisplatin 75 mg/m2 on day 2 at 21-day intervals for four cycles. RESULTS: Such sequential couplets are feasible. Myelotoxicity was the major toxic effect, but it was of short duration. The granulocyte nadir with topotecan/cisplatin occurred late (median, day 18), so retreatment on day 21 was not always possible. There was no unexpected nonhematologic toxicity. The regimen was active in this group of patients who had undergone largely suboptimal debulking surgery. In 34 patients with clinically measurable disease, the overall response rate was 78%, and 30 (77%) of the 39 patients with elevated CA 125 levels at baseline had normalization of CA 125 levels by the end of therapy. CONCLUSION: Sequential couplets of cisplatin/topotecan followed by paclitaxel/cisplatin are feasible. The efficacy data in this suboptimal group of patients has encouraged us to proceed with a randomized study based on this approach.

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