Is Neo-adjuvant Chemotherapy a “Waiver” of Extensive Upper Abdominal Surgery in Advanced Epithelial Ovarian Cancer?

Kang, Sokbom; Jong, Yoo Heon; Hwang, Jong Ha; Lim, Myong Cheol; Seo, Seung‐Woo; Yoo, Chong-Woo; Park, Sang-Yoon

doi:10.1245/s10434-011-1830-0

Cited by 18 publications

(11 citation statements)

References 15 publications

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“…The sites with high incidence rates of initial dissemination and pRT after NACT included the rectosigmoid colon, greater omentum, right diaphragm, paracolic gutters, and vesicouterine pouch. Our study results support the argument that the role of NACT is to shrink rather than eradicate tumors [29].…”

Section: Discussionsupporting

confidence: 89%

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Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

et al. 2020

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Objective: This study aimed to evaluate the presence of pathological residual tumor (pRT) in each initial disseminated site after neoadjuvant chemotherapy (NACT) to assess the appropriate surgical margins during interval debulking surgery (IDS) for a favorable prognosis. Methods: This prospective descriptive study included patients with stage IIIC-IV epithelial ovarian, fallopian tubal, and peritoneal cancer. One hundred eleven patients underwent diagnostic exploratory laparotomy, and their initial intra-abdominal dissemination statuses were recorded. Any tumor >1 cm in diameter found during the exploratory laparotomy was resected during IDS even if it was macroscopically invisible after NACT. The pRT rate after NACT and negative predictive value (NPV; probability that sites with macroscopically invisible tumors have no pRT) during IDS were assessed in each disseminated site. Results: A median of 5 NACT cycles were performed. Sites with a high incidence of pRT and low NPV included the rectosigmoid colon (71.4%, 38.6%), transverse mesentery (70.3%, 50.0%), greater omentum (68.3%, 51.7%), right diaphragm (61.9%, 48.1%), paracolic gutters (61.1%, 50.0%), and vesicouterine pouch (56.6%, 50.0%). Organs/tissues with a high incidence of pRT featured a low NPV. The median progression-free survival and overall survival in this cohort were 27.7 and 71.9 months, respectively. Conclusion: Even if a disseminated site >1 cm in diameter before NACT is invisible during IDS, microscopic disease remains present within it. The appropriate surgical margins for IDS with a favorable prognosis could be secured by resecting a lesion of >1 cm before NACT even if it is invisible during IDS.

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Section: Discussionsupporting

confidence: 89%

“…In conclusion, the role of NACT is to shrink rather than eradicate tumors [29]. Aggressive surgery using a resection line based on the initial disease during IDS leads to favorable survival outcomes [30].…”

Section: Discussionmentioning

confidence: 99%

Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

et al. 2020

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“…We believe that the criteria for NAC should be individualized based on surgeon experience, hospital capacity, and the cooperation of surgeons from other departments [12132930]. The criteria changed with the evolution of surgical experience and technique [11].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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ObjectiveTo 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.MethodsMedical 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.ResultsOf 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.ConclusionExtensive 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.

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“…Additionally analysis of risk factors such as age, performance status, nutrition, and obesity can allow surgeons to sensibly triage those patients at highest risk of serious morbidity to alternative primary treatment. Contemporary studies from experienced centers clearly indicate that complete cytoreduction can be achieved in up to 60% of patients with FIGO stage IIIC-IV ovarian cancer, such that the feasibility argument is highly related to center expertise [ 23 ]. With these issues in mind, we will now take a look at recent evidences supporting the survival benefit from aggressive surgical cytoreduction.…”

Section: Evidences Supporting Radical Surgerymentioning

confidence: 99%

Role of aggressive surgical cytoreduction in advanced ovarian cancer

et al. 2015

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Ovarian cancer is the eighth most frequent cancer in women and is the most lethal gynecologic malignancy worldwide. The majority of ovarian cancer patients are newly diagnosed presenting with advanced-stage disease. Primary cytoreductive surgery and adjuvant taxane- and platinum-based combination chemotherapy are the standard treatment for advanced ovarian cancer. A number of studies have consistently shown that successful cytoreductive surgery and the resultant minimal residual disease are significantly associated with survival in patients with this disease. Much has been written and even more debated regarding the competing perspectives of biology of ovarian cancer versus the value of aggressive surgical resection. This review will focus on the current evidences and outcomes supporting the positive impact of aggressive surgical effort on survival in the primary management of ovarian cancer.

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Is Neo-adjuvant Chemotherapy a “Waiver” of Extensive Upper Abdominal Surgery in Advanced Epithelial Ovarian Cancer?

Abstract: A significant proportion of patients who received NAC still have gross metastatic tumors requiring EUAS. Gynecologic oncologists should be familiar with EUAS and be ready to perform any required procedures together with multidisciplinary teams, even in the patients who have received NAC.

Cited by 18 publications

References 15 publications

Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer

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

Role of aggressive surgical cytoreduction in advanced ovarian cancer

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