Does time interval between surgery and intraperitoneal chemotherapy administration in advanced ovarian cancer carry a prognostic impact? An NRG Oncology/Gynecologic Oncology Group study ancillary study

Abstract

Objectives To determine the relationship of the time from surgery to intraperitoneal (IP) chemotherapy (TSIC) initiation with survival of patients with stage III epithelial ovarian cancer (EOC) patients using ancillary data from cooperative group clinical trials. Methods Data from 420 patients with stage III EOC treated with IP chemotherapy under GOG-0114 and 172 were reviewed. The Cox proportional hazards model was used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on PFS and OS. Results The median TSIC was 62.5 days (interquartile range 28-83). The median TSIC was longer for patients in GOG-0114 vs those in GOG-172 (83 vs 26 days, p <0.001). TSIC was significantly associated (P = 0.049) with PFS: each 10% increase in TSIC (days) decreases the risk of progression by 3%. TSIC was not significantly associated with OS in this model. In a linear regression model, gross residual disease was significantly associated with shorter TSIC (R2 -0.141, 95%CI -0.217, -0.064, p < 0.001). When only data from GOG-172 were considered, no statistical significant association was found between TSIC and PFS or OS. Conclusions In this ancillary data study, TSIC was not associated with improved OS in patients with stage III epithelial ovarian cancer. TSIC was significantly associated with PFS for the entire cohort, suggesting increase in PFS with longer TSIC. However, this was not found when only data from GOG 172 or GOG 114 were analyzed separately. Hence, the relationship between IP chemotherapy initiation and time from surgery needs to be studied further.

Impact of interval from primary cytoreductive surgery to initiation of adjuvant chemotherapy in advanced epithelial ovarian cancer

“…The amount of residual disease is one of the factors influencing the interval between surgery and start of adjuvant chemotherapy in EOC. Notably, other researchers reported that intravenous or intraperitoneal adjuvant chemotherapy in EOC was started 2–6 days earlier for women with any gross residual disease than for those with microscopic residual of 0 mm, which is consistent with the present results (9 vs 12 days; P <0.001). Surgeons might have started adjuvant chemotherapy at an earlier time point after optimal 1–9 mm resection.…”

“…Complications, medical co‐morbidities, and Eastern Cooperative Oncology Group scores might have influenced the interval between surgery and chemotherapy; however, these data were not taken into account in the analysis. Moreover, different medical systems have various health system logistics for referrals and wait times that may have affected the treatment interval . A strength of the study is the large cohort.…”

“…At present, however, there is no consensus on the optimal time interval between surgery and initiation of chemotherapy. Some clinical trials have allowed a delay of up to 6–8 weeks after surgery before systemic therapy is initiated for women with EOC …”

“…Some clinical trials have allowed a delay of up to 6-8 weeks after surgery before systemic therapy is initiated for women with EOC. 4,5 The aim of the present study was to investigate the impact on OS of the interval from primary cytoreductive surgery to initiation of adjuvant chemotherapy in advanced EOC (FIGO stages III and IV) by using pooled data from two independent cohorts attending two high-volume cancer centers in Canada and South Korea.…”

The interval between the primary cytoreductive surgery and adjuvant chemotherapy in patients with advanced ovarian cancer

“…In the analysis of the first group of patients (the time interval before the start of ACT to 1 month), we obtained a variable series of periods (in months) between the start of special treatment and the establishment of death from the underlying disease and / or its complications: 10,10,12,14,15,15,16,17,18,18,19,19,20,21,22,25,26,33,35,39,43,43,43,51,53,56,63,85,101,126. Variation indices: weighted average -36, mode -43, median -26, standard deviation -27.513.…”