Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer
Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
,
Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
,
Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
,
Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
,
Radiadiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
,
Radiadiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
,
Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
1 Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
2 Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
3 Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
4 Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
5 Radiadiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
6 Radiadiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemo therapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT- IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and significant increase progression-free survival and overall survival. Both responses to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian cancer.
Ferlay, J., Steliarova-Foucher, E., Lortet-Tieulent, J., Rosso, S., Coebergh, J.-W.W., Comber, H., et al. (2013) Cancer Incidence and Mortality Patterns in Europe: Estimates for 40 Countries in 2012. European Journal of Cancer, 49, 1374-1403. https://doi.org/10.1016/j.ejca.2012.12.027
Group USCSW (2010) United States Cancer Statistics: 1999-2006 Incidence and Mortality Web-Based Report. Atlanta US Dep Heal Hum Serv Centers Dis Control Prev Natl Cancer Inst.
Meyer, J.I., Kennedy, A.W., Friedman, R., Ayoub, A. and Zepp, R.C. (1995) Ovarian Carcinoma: Value of CT in Predicting Success of Debulking Surgery. American Journal of Roentgenology, 165, 875-878. https://doi.org/10.2214/ajr.165.4.7676985
Bristow, R.E., Duska, L.R., Lambrou, N.C., Fishman, E.K., O’Neill, M.J., Trimble, E.L., et al. (2000) A Model for Predicting Surgical Outcome in Patients with Advanced Ovarian Carcinoma using Computed Tomography. Cancer, 89, 1532-1540. https://doi.org/10.1002/1097-0142(20001001)89:7 3.0.CO;2-A
Harter, P., Gnauert, K., Hils, R., Lehmann, T.G., Fisseler-Eckhoff, A., Traut, A., et al. (2007) Pattern and Clinical Predictors of Lymph Node Metastases in Epithelial Ovarian Cancer. International Journal of Gynecological Cancer, 17, 1238-1244. https://doi.org/10.1111/j.1525-1438.2007.00931.x
Maggioni, A., Panici, P.B., Dell’Anna, T., Landoni, F., Lissoni, A., Pellegrino, A., et al. (2006) Randomised Study of Systematic Lymphadenectomy in Patients with Epithelial Ovarian Cancer Macroscopically Confined to the Pelvis. British Journal of Cancer, 95, 699-704. https://doi.org/10.1038/sj.bjc.6603323
Lou, E., Vogel, R.I., Gerber, M., Grad, A., Monu, M., Lukaszewski, T., et al. (2017) Prospective Assessment of Circulating Tumor Cells (CTCs) in Women Undergoing Surgery for Suspected Ovarian Cancer. Gynecologic Oncology, 145, 92. https://doi.org/10.1016/j.ygyno.2017.03.215
Eisenkop, S.M., Spirtos, N.M., Montag, T.W., Nalick, R.H. and Wang, H.J. (1992) The Impact of Subspecialty Training on the Management of Advanced Ovarian Cancer. Gynecologic Oncology, 47, 203-209. https://doi.org/10.1016/0090-8258(92)90107-T
Frei 3rd, E. (1982) Clinical Cancer Research: An Embattled Species. Cancer, 50, 1979-1992. https://doi.org/10.1002/1097-0142(19821115)50:10 3.0.CO;2-D
Sujlana, P., Skrok, J. and Fayad, L.M. (2017) Review of Dynamic Contrast-Enhanced MRI: Technical Aspects and Applications in the Musculoskeletal System. Journal of Magnetic Resonance Imaging. https://doi.org/10.1002/jmri.25810
Bellaton, E., Bertozzi, A.I., Behar, C., Chastagner, P., Brisse, H., Sainte-Rose, C., et al. (2003) Neoadjuvant Chemotherapy for Extensive Unilateral Retinoblastoma. British Journal of Ophthalmology, 87, 327-329. https://doi.org/10.1136/bjo.87.3.327
Ansquer, Y., Leblanc, E., Clough, K., Morice, P., Dauplat, J., Mathevet, P., et al. (2001) Neoadjuvant Chemotherapy for Unresectable Ovarian Carcinoma: A French Multicenter Study. Cancer, 91, 2329-2334. https://doi.org/10.1002/1097-0142(20010615)91:12 3.0.CO;2-U
Deraco, M., Raspagliesi, F. and Kusamura, S. (2003) Management of Peritoneal Surface Component of Ovarian Cancer. Surgical Oncology Clinics of North America, 12, 561-583. https://doi.org/10.1016/S1055-3207(03)00027-9
Michielsen, K., Dresen, R., Vanslembrouck, R., De Keyzer, F., Amant, F., Mussen, E., et al. (2017) Diagnostic Value of Whole Body Diffusion-Weighted MRI Compared to Computed Tomography for Pre-Operative Assessment of Patients Suspected for Ovarian Cancer. European Journal of Cancer, 83, 88-98. https://doi.org/10.1016/j.ejca.2017.06.010
Randall, T.C. and Rubin, S.C. (2001) Cytoreductive Surgery for Ovarian Cancer. Surgical Clinics of North America, 81, 871-883. https://doi.org/10.1016/S0039-6109(05)70171-7
Vergote, I., De Wever, I., Tjalma, W., Van Gramberen, M., Decloedt, J. and van Dam, P. (1998) Neoadjuvant Chemotherapy or Primary Debulking Surgery in Advanced Ovarian Carcinoma: A Retrospective Analysis of 285 Patients. Gynecologic Oncology, 71, 431-436. https://doi.org/10.1006/gyno.1998.5213
Kayikcioglu, F., Kose, M.F., Boran, N., Caliskan, E. and Tulunay, G. (2001) Neoadjuvant Chemotherapy or Primary Surgery in Advanced Epithelial Ovarian Carcinoma. International Journal of Gynecological Cancer, 11, 466-470. https://doi.org/10.1046/j.1525-1438.2001.01064.x
Vergote, I., de Wever, I., Tjalma, W., Van Gramberen, M., Decloedt, J. and Van Dam, P. (2000) Interval Debulking Surgery: An Alternative for Primary Surgical Debulking? Seminars in Surgical Oncology, 19, 49-53. https://doi.org/10.1002/1098-2388(200007/08)19:1 3.0.CO;2-Z
Onda, T., Kobayashi, H., Nakanishi, T., Hatae, M., Iwasaka, T., Konishi, I., et al. (2009) Feasibility Study of Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Stage III/IV Ovarian, Tubal, and Peritoneal Cancers: Japan Clinical Oncology Group Study JCOG0206. Gynecologic Oncology, 113, 57-62. https://doi.org/10.1016/j.ygyno.2008.12.027
Schwartz, P.E. (2002) Neoadjuvant Chemotherapy for the Management of Ovarian Cancer. Best Practice & Research: Clinical Obstetrics & Gynaecology, 16, 585-596. https://doi.org/10.1053/beog.2002.0304
Vergote, I., Amant, F., Kristensen, G., Ehlen, T., Reed, N.S. and Casado, A. (2011) Primary Surgery or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery in Advanced Ovarian Cancer. European Journal of Cancer, 47, S88-S92. https://doi.org/10.1016/S0959-8049(11)70152-6
Lee, S., Kim, B., Lee, J., Park, C., Lee, J. and Bae, D. (2006) Preliminary Results of Neoadjuvant Chemotherapy with Paclitaxel and Cisplatin in Patients with Advanced Epithelial Ovarian Cancer Who Are Inadequate for Optimum Primary Surgery. Journal of Obstetrics and Gynaecology Research, 32, 99-106. https://doi.org/10.1111/j.1447-0756.2006.00359.x
Surwit, E., Childers, J., Atlas, I., Nour, M., Hatch, K., Hallum, A., et al. (1996) Neoadjuvant Chemotherapy for Advanced Ovarian Cancer. International Journal of Gynecological Cancer, 6, 356-361. https://doi.org/10.1046/j.1525-1438.1996.06050356.x
Kuhn, W., Rutke, S., Spathe, K., Schmalfeldt, B., Florack, G., von Hundelshausen, B., et al. (2001) Neoadjuvant Chemotherapy Followed by Tumor Debulking Prolongs Survival for Patients with Poor Prognosis in International Federation of Gynecology and Obstetrics Stage IIIC Ovarian Carcinoma. Cancer, 92, 2585-2591. https://doi.org/10.1002/1097-0142(20011115)92:10 3.0.CO;2-#
Rose, P.G. (2002) A Phase III Randomized Study of Interval Secondary Cytoreduction in Patients with Advanced Stage Ovarian Carcinoma with Suboptimal Residual Disease: A Gynecologic Oncology Group Study. Proceedings of American Society of Clinical Oncology, 21, 201a.