J Gynecol Oncol.  2018 Jul;29(4):e63. 10.3802/jgo.2018.29.e63.

Impact of increased utilization of neoadjuvant chemotherapy on survival in patients with advanced ovarian cancer: experience from a comprehensive cancer center

• Lee YJ
• Chung YS
• Lee JY
• Nam EJ
• Kim SW
• Kim S
• Kim YT

• KMID: 2417451
• DOI: http://doi.org/10.3802/jgo.2018.29.e63

Abstract

OBJECTIVE
The choice between primary debulking surgery (PDS) and neoadjuvant chemotherapy (NAC) in advanced ovarian cancer remains controversial. We evaluated NAC use in our center before and after results from a randomized trial were published, with the aim to determine the impact of changes in the neoadjuvant strategy on survival in advanced-stage ovarian cancer.
METHODS
We retrospectively investigated the clinical course of 435 patients with ovarian, tubal, or peritoneal carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage III or IV). According to the period of treatment, we stratified patients into a control group (n=216; diagnosed between 2006 and 2010; 83.8% underwent PDS) and a study group (n=219; diagnosed between 2011 and 2014; 48.9% received NAC followed by interval debulking surgery [IDS]).
RESULTS
There were no between-group differences in age, body mass index, histology findings, or tumor grade. Compared to patients in the control group, those in the study group were more likely to receive NAC followed by IDS as first-line treatment (48.9% vs. 16.2%; p < 0.001), cytoreductive surgery to no-residual disease (21.5% vs. 10.2%; p < 0.001), or radical surgery (57.5% vs. 35.6%; p < 0.001). However, there was no between-group difference in postoperative morbidity. Kaplan-Meier analysis showed no between-group differences in progression-free or overall survival (p=0.449 and 0.952, respectively).
CONCLUSION
NAC incorporation resulted in increased optimal cytoreduction rates although no significant differences in survival outcomes were noted. NAC is advantageous for patients with high perioperative morbidity or unresectable disease.

Keyword

Ovarian Neoplasms; Neoadjuvant Therapy; Debulking Surgical Procedure; Chemotherapy, Adjuvant

MeSH Terms

Body Mass Index
Chemotherapy, Adjuvant
Cytoreduction Surgical Procedures
Drug Therapy*
Gynecology
Humans
Kaplan-Meier Estimate
Neoadjuvant Therapy
Obstetrics
Ovarian Neoplasms*
Retrospective Studies

Figure

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  Fig. 1. Change in NAC use between 2006 and 2014. NAC, neoadjuvant chemotherapy; PDS, primary debulking surgery.

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  Fig. 2. Kaplan-Meier curves of PFS (A) and OS (B) according to time period (2006–2010 vs. 2011–2014). OS, overall survival; PFS, progression-free survival.

Reference

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