Does Time-to-Chemotherapy Impact the Outcomes of Resected Ovarian Cancer? Meta-analysis of Randomized and Observational Data

Usón, Pedro Luiz Serrano; Bugano, Diogo Diniz Gomes; França, Monique Sedlmaier; Antunes, Y.P.P.V.; Taranto, Patrícia; Kaliks, Rafael Aliosha; Giglio, Auro del

doi:10.1097/igc.0000000000000923

Cited by 17 publications

(22 citation statements)

References 25 publications

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“…Our finding is like that reported in a study conducted by Nagel et al, where the authors pointed out there was no association between OS rates and changes in scheduled chemotherapy; also indicating the importance of personalized treatment plans [30]. The meta-analysis by Usón et al [31] indicated that there was no correlation between the TTC after surgery and a higher risk of death, when assessing patients' 3-year survival rate following surgery with optimal TTC between 20 and 40 days. However, some authors have suggested that the time elapsed before the start of chemotherapy is crucial, when considered in relation to the completeness of the cytoreductive surgery.…”

Section: Discussionsupporting

confidence: 89%

An analysis of the influence of infection on overall survival rates, following modified posterior pelvic exenteration for advanced ovarian cancer

Szymankiewicz¹,

Dziobek²,

Sznajdorwska³

et al. 2018

Ginekol Pol

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Objectives:The aim of our study was to determine the association between the appearance of infection after modified posterior pelvic exenteration (MPE) and the time to adjuvant chemotherapy (TTC), and to examine whether infection has any impact on clinical results by delaying the start of chemotherapy. Material and methods:Our retrospective study analyzed 77 patients who had undergone MPE followed by adjuvant chemotherapy. Postoperatively, either there was no residual tumor or, the residual tumor was less than 2.5 mm, in 76.7% of the study patients. Our study group was divided into two subgroups for comparison; the first group consisted of 41 patients with postoperative infections, and the second group of 36 patients had no infections. The infections of the first group were monitored during a 90-day postoperative period. Median TTC and overall survival rates (OS) were determined for those patients who developed an infection as well as for those who did not. Results:The expected 5-year survival rate was 0.40 (SD = 0.09) for those patients without infection and 0.17 (SD = 0.07) for those patients with infection. The survival curves of patients with infection and those without infection were significantly different statistically (p = 0.038). The median TTC differed significantly for those patients who developed infection compared with those patients who did not develop infection (37 days compared with 27.5 days respectively, p = 0.024); and patients without infection were statistically more likely to receive chemotherapy within 25 days following surgery than in the subsequent 25-42-day period compared with those patients who did develop infection (p = 0.048). No statistically significant differences were found between the two groups in relation to results following the initiation of chemotherapy during the first 42 days postoperatively (p = 0.445). Conclusions:The absence of postoperative infection was associated with better survival rates. Patients with infection experienced a longer time interval between surgery and the start of chemotherapy, without negative impact to their overall survival rates.

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Section: Discussionsupporting

confidence: 89%

An analysis of the influence of infection on overall survival rates, following modified posterior pelvic exenteration for advanced ovarian cancer

Szymankiewicz¹,

Dziobek²,

Sznajdorwska³

et al. 2018

Ginekol Pol

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“…In a meta-analysis of the impact of intervals between surgery and initiation of adjuvant chemotherapy in the primary treatment of EOC, the intervals were not associated with survival [11]. However, the studies included in the meta-analysis were heterogeneous in terms of the level of residual disease and definitions of early vs. late chemotherapy, which might have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

“…; nevertheless, we do not think that these differences have influenced our results. However, as the role of intervals is influenced by different definitions of early vs. late chemotherapy and the level of residual disease among various studies based on the primary treatment setting in EOC [10, 11], further studies are needed to draw robust conclusions. Since we did not have a control group of patients who did not receive postoperative chemotherapy after SCS, we cannot determine the role of SCS itself on survival.…”

Section: Discussionmentioning

confidence: 99%

“…For ovarian cancers, this topic remains controversial since studies investigating the effect of intervals between maximal cytoreductive surgery and adjuvant chemotherapy are very heterogeneous in terms of patients selection and controlling for bias originated from poor study design [10]. Although a meta-analysis in ovarian cancer suggested a lack of association between intervals and survival in the primary treatment setting [11], some reports have showed negative impacts on survival for delayed intervals in patients with microscopic residuals or residuals of 1–9 mm, suggesting that there may be subsets of patients who may benefit from earlier adjuvant chemotherapy during primary treatment [12–18]. However, it remains unknown whether the intervals between SCS and adjuvant chemotherapy have any effects on survival in recurrent EOC.…”

Section: Introductionmentioning

confidence: 99%

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Interval between secondary cytoreductive surgery and adjuvant chemotherapy is not associated with survivals in patients with recurrent ovarian cancer

et al. 2019

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BackgroundSecondary cytoreductive surgery (SCS) is possible in selected patients with recurrent epithelial ovarian cancer (EOC). The goal of SCS is complete resection, although chemotherapy is always followed. Delayed intervals between primary debulking surgery and adjuvant chemotherapy was reported to be associated with poorer survivals, however, the role of intervals in recurrent disease is still unknown.Materials and methodsThis retrospective cohort study reviewed data from electronic medical records of women with recurrent EOC treated at Samsung Medical Centre, Seoul, Korea, between January 1, 2002, and December 31, 2015. Patients who underwent SCS with adjuvant chemotherapy for recurrent EOC were eligible. We defined intervals as the period between the day of SCS and the first cycle of adjuvant chemotherapy.ResultsSeventy-nine patients were eligible for this study. Their median age was 48 (range, 18–69) years and median interval between the date of SCS and initiation of adjuvant chemotherapy was 10 (range, 4–115) days. The rate of complete resection was 72.2% (57/79). Division of the patients by interval (Group 1, interval ≤ 10 days; Group 2, interval > 10 days) revealed no difference in clinical parameters. No gross residual disease after SCS (no vs. any gross residual, p = 0.002) and longer platinum-free survival (over 12 vs. 6–12 months, p = 0.023) were independent favorable prognostic factors in Cox model; however, the intervals did not affect survival.ConclusionsDelayed intervals to adjuvant chemotherapy after secondary cytoreductive surgery is not associated with decreased survivals. It is important to identify recurrent EOC patients who might have no gross residual disease following SCS. Moreover, surgeons should strive for complete resection.

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“…It has been reported that a longer interval between surgery and initiation of adjuvant chemotherapy led to a 22% decrease in OS of ovarian cancer while relative OS decreased by 4% for each week of delay in initiating adjuvant chemotherapy [9]. In a meta-analysis, Uson et al [10] reported that time to adjuvant chemotherapy (between 20 and 40 days) following ovarian cancer surgery with curative intent was not associated with a higher risk of disease recurrence or death. However, this association was influenced by the rate of optimal debulking.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of delay in time to adjuvant chemotherapy after HIPEC and its impact on oncological outcome in advanced epithelial ovarian cancer

Somashekhar

Yethadka

Ashwin

et al. 2020

Pleura and Peritoneum

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ObejectivesOptimal cytoreductive surgery (CRS), followed by adjuvant chemotherapy, is a major predictor of oncological outcome in patients with advanced epithelial ovarian carcinoma (EOC). It is not clear if a delayed start of adjuvant chemotherapy negatively impacts on the oncological outcome.MethodsProspective registry study on 75 patients treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). Adjuvant chemotherapy was started within 42 days in 41 patients (55%), later on in 34 patients (45%). Multivariate analyses of preoperative factors were done on survival outcome. Outcomes were recurrence-free survival (RFS) and overall survival (OS).ResultsThere was no difference in RFS after early introduction (median 35 months) vs. late introduction of chemotherapy (median 32 months), p = 0.17. Median OS in patients with late introduction of chemotherapy was 46 months and was not yet reached in early introduction group.ConclusionsIn this exploratory study in a small group of women with advanced EOC, starting adjuvant chemotherapy more than 6 weeks after CRS and HIPEC did not deteriorate significantly RFS or OS. Well-designed clinical studies are still needed to evaluate the interplay of HIPEC and the point of time of postoperative adjuvant chemotherapy in this indication.

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Does Time-to-Chemotherapy Impact the Outcomes of Resected Ovarian Cancer? Meta-analysis of Randomized and Observational Data

Cited by 17 publications

References 25 publications

An analysis of the influence of infection on overall survival rates, following modified posterior pelvic exenteration for advanced ovarian cancer

An analysis of the influence of infection on overall survival rates, following modified posterior pelvic exenteration for advanced ovarian cancer

Interval between secondary cytoreductive surgery and adjuvant chemotherapy is not associated with survivals in patients with recurrent ovarian cancer

Evaluation of delay in time to adjuvant chemotherapy after HIPEC and its impact on oncological outcome in advanced epithelial ovarian cancer

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