Neoadjuvant Chemotherapy in Patients with Advanced Epithelial Ovarian Cancer

Lee, Sun Joo; Lee, Jeong Won; Park, Chang Soo; Kim, Byoung Gie; Lee, Je Ho; Bae, Duk Soo

Abstract

OBJECTIVE
Neoadjuvant chemotherapy has been proposed as an alternative approach to conventional radical surgery with an aim to improve morbidity and survival. General acceptance of neoadjuvant chemotherapy as an alternative to primary surgery for patients who are not ideal surgical candidates remains controversial. The purpose of this study was to evaluate the efficacy of neoadjuvant chemotherapy in advanced epithelial ovarian cancer which are inadequate for primary optimal surgery.
METHODS
A retrospective analysis of 18 patients was conducted to compare outcomes from December, 1995 to March, 2003. During the same period, 45 patients with advanced epithelial ovarian cancer received tumor debulking surgery followed by adjuvant chemotherapy. From this group, 18 patients were selected according to age, histologic types and FIGO stage. A comparison of both groups of patients was done. The operation records and pathologic reports were reviewed and CT/MRI images and pathologic slides were reevaluated. Last follow-up of medical records and phone-call were used to find out patient's status. SPSS 10.0 (SPSS Inc. Chicago, IL) was used to confirm a statistical significance.
RESULTS
The optimal debulking (<2.0 cm) was possible in 14 cases (77.8%) compared to conventional therapy group in 8 cases (44.4%, p=0.040). The mean estimated blood loss was 620 cc (range 300-1500 cc) in neoadjuvant therapy group and 1061 cc (range 300-3500 cc) in conventional therapy group (p=0.040). Eight cases of optimal debulking relapsed (61.5%). The mean disease-free interval and overall survival of neoadjuvant therapy cases were 18.0 months and 48.3 months, respectively. The mean disease-free interval and overall survival of conventional therapy group were 23.9 months and 46.1 months respectively. There were no significant differences of disease-free survival and overall survival in two groups (p=0.482, p=0.605 respectively).
CONCLUSION
Neoadjuvant chemotherapy provided higher rate of optimum cytoreduction and less amount of blood loss in patients with advanced epithelial ovarian cancer inadequate for primary optimum surgery. The results suggest that neoadjuvant chemotherapy results in survival rates that are comparable with those associated with primary cytoreductive surgery.