J Gynecol Oncol.  2011 Sep;22(3):183-187. 10.3802/jgo.2011.22.3.183.

Neoadjuvant chemotherapy in ovarian, primary peritoneal and tubal carcinoma: can imaging results prior to interval debulking predict survival?

• Menczer J
• Usviatzov
• Ben-Shem E
• Golan A
• Levy T

• KMID: 2055706
• DOI: http://doi.org/10.3802/jgo.2011.22.3.183

Abstract

OBJECTIVE
To assess whether there is an association between improvement of computed tomography imaging results prior to interval debulking with survival in patients treated by neoadjuvant chemotherapy.
METHODS
The clinical and outcome data of all advanced ovarian, primary peritoneal and tubal carcinoma patients who after diagnosis had neoadjuvant chemotherapy and underwent interval debulking during the period 2000-2010, were abstracted. Results of computed tomography imaging at diagnosis and prior to interval debulking were compared. Two parameters were assessed: the change of the size and number of abnormal findings and the change in the amount of ascites. CA-125 level response was also calculated. An assessment of progression free survival and of survival by the Kaplan-Meier method was made according to the change in computed tomography imaging results and according to response of CA-125 levels.
RESULTS
The median progression free survival and the median survival of the 37 study group patients were 7.9 and 49.2 months respectively. No significant difference in progression free survival and survival was observed between patients with marked improvement in the computed tomography results and those with less desirable results (7.93 vs. 7.23 months respectively, p=0.89; 45.8% vs. 52.5% months respectively, p=0.95). There were also no statistically significant difference according to CA-125 level response.
CONCLUSION
It seems that neither improvement in imaging results nor CA-125 level response can predict the survival of ovarian carcinoma patients prior to interval debulking after neoadjuvant chemotherapy.

Keyword

Imaging results; Interval debulking; Neoadjuvant chemotherapy; Ovarian carcinoma; Survival prediction

MeSH Terms

Ascites
Disease-Free Survival
Humans

Figure

• 

  Fig. 1 Progression-free survival according to improvement of computed tomography findings.

Reference

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010. 60:277–300.

2. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975. 42:101–104.

3. National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol. 1994. 55(3 Pt 2):S4–S14.

4. Marsden DE, Friedlander M, Hacker NF. Current management of epithelial ovarian carcinoma: a review. Semin Surg Oncol. 2000. 19:11–19.

5. Dauplat J, Le Bouedec G, Pomel C, Scherer C. Cytoreductive surgery for advanced stages of ovarian cancer. Semin Surg Oncol. 2000. 19:42–48.

6. Schwartz PE. What is the role of neoadjuvant chemotherapy in the management of ovarian cancer? Oncology (Williston Park). 2008. 22:1118–1125.

7. Tangjitgamol S, Manusirivithaya S, Laopaiboon M, Lumbiganon P, Bryant A. Interval debulking surgery for advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 2010. (10):CD006014.

8. Weinberg LE, Rodriguez G, Hurteau JA. The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer. J Surg Oncol. 2010. 101:334–343.

9. Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010. 363:943–953.

10. Nelson BE, Rosenfield AT, Schwartz PE. Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol. 1993. 11:166–172.

11. Bristow RE, Duska LR, Lambrou NC, Fishman EK, O'Neill MJ, Trimble EL, et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer. 2000. 89:1532–1540.

12. Dowdy SC, Mullany SA, Brandt KR, Huppert BJ, Cliby WA. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer. 2004. 101:346–352.

13. Chi DS, Venkatraman ES, Masson V, Hoskins WJ. The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol. 2000. 77:227–231.

14. Martinez-Said H, Rincon DG, Montes de Oca MM, Ruiz GC, Ponce JL, Lopez-Graniel CM. Predictive factors for irresectability in advanced ovarian cancer. Int J Gynecol Cancer. 2004. 14:423–430.

15. Le T, Faught W, Hopkins L, Fung-Kee-Fung M. Importance of CA125 normalization during neoadjuvant chemotherapy followed by planned delayed surgical debulking in patients with epithelial ovarian cancer. J Obstet Gynaecol Can. 2008. 30:665–670.

16. Le T, Hopkins L, Faught W, Fung-Kee-Fung M. The lack of significance of Ca125 response in epithelial ovarian cancer patients treated with neoadjuvant chemotherapy and delayed primary surgical debulking. Gynecol Oncol. 2007. 105:712–715.

17. Tate S, Hirai Y, Takeshima N, Hasumi K. CA125 regression during neoadjuvant chemotherapy as an independent prognostic factor for survival in patients with advanced ovarian serous adenocarcinoma. Gynecol Oncol. 2005. 96:143–149.

18. Tiersten AD, Moon J, Smith HO, Wilczynski SP, Robinson WR 3rd, Markman M, et al. Chemotherapy resistance as a predictor of progression-free survival in ovarian cancer patients treated with neoadjuvant chemotherapy and surgical cytoreduction followed by intraperitoneal chemotherapy: a Southwest Oncology Group Study. Oncology. 2009. 77:395–399.

19. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009. 45:228–247.

20. Kang S, Kim TJ, Seo SS, Kim BG, Bae DS, Park SY. Role of extended chemotherapy in advanced ovarian cancer patients with high posttreatment serum CA-125 levels. Gynecol Obstet Invest. 2011. 72:50–54.

21. Brun JL, Rouzier R, Selle F, Houry S, Uzan S, Darai E. Neoadjuvant chemotherapy or primary surgery for stage III/IV ovarian cancer: contribution of diagnostic laparoscopy. BMC Cancer. 2009. 9:171.