J Gynecol Oncol.  2017 Jul;28(4):e48. 10.3802/jgo.2017.28.e48.

Survival outcomes after extensive cytoreductive surgery and selective neoadjuvant chemotherapy according to institutional criteria in bulky stage IIIC and IV epithelial ovarian cancer

• Lim MC
• Yoo HJ
• Song YJ
• Seo SS
• Kang S
• Kim SH
• Yoo CW
• Park SY

• KMID: 2413432
• DOI: http://doi.org/10.3802/jgo.2017.28.e48

Abstract

OBJECTIVE
To investigate the survival outcomes in patients with bulky stage IIIC and IV ovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvant chemotherapy (NAC) according to institutional criteria.
METHODS
Medical records for advanced ovarian cancer patients who were treated at National Cancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewed in the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases were included. Current NCC indication for NAC is determined based on patients' performance status and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially including chemotherapy-resistant cancer cells, were surgically removed.
RESULTS
Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136 (49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achieved in 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. The median progression-free survival (PFS) and overall survival (OS) time were 20 months and not reached, but might be estimated more than 70 months in the PDS group and 15 and 70 months in the NAC group, respectively.
CONCLUSION
Extensive cytoreductive surgery to minimize residual tumor and selective use of NAC based on the institutional criteria could result in improved survival outcomes. Until further studies can be done to define the selection criteria for NAC after surgery, institutional criteria for NAC should consider the ability of the surgeon and institutional capacity.

Keyword

Ovarian Neoplasms; Neoadjuvant Therapy; Drug Therapy; Debulking Surgical Procedures; Standards

MeSH Terms

Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Cancer Care Facilities/standards
Carboplatin/administration & dosage
Chemotherapy, Adjuvant
*Cytoreduction Surgical Procedures
Disease-Free Survival
Female
Humans
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Neoplasm, Residual
Neoplasms, Glandular and Epithelial/*secondary/*therapy
Ovarian Neoplasms/*pathology/*therapy
Paclitaxel/administration & dosage
Practice Guidelines as Topic
Retrospective Studies
Survival Rate
Carboplatin
Paclitaxel