Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery and the Risk of Platinum Resistance in Epithelial Ovarian Cancer

Costa, Alexandre André Balieiro Anastácio da; Valadares, Camila V.; Baiocchi, Glauco; Mantoan, Henrique; Saito, Augusto Obuti; Sanches, Solange Moraes; Guimarães, A. P.; Achatz, Maria Isabel

doi:10.1245/s10434-015-4623-z

Cited by 43 publications

(35 citation statements)

References 24 publications

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“…However, if rates of complete surgical cytoreduction were more than double in IDS arm compared with PDS arm (51.2% vs 19.4% in the study of Vergote et al 21 and 39% vs 17% in that of Kehoe et al, 22 the prognostic relevance of the achievement of no gross RD after surgery could be quite different for patients undergoing PDS and for those undergoing IDS. In the present investigation, 30 In the present investigation, among the patients with no gross RD after surgery, tumor recurred in 57.4% of the 115 who underwent PDS vs 87.5% of the 32 who underwent IDS (P = 0.001). The IDS group showed a trend to a higher recurrence rate within 6 months (6.2% vs 1.7%) and a significantly higher recurrence rate between 6 and 12 months (37.5% vs 15.6%; P = 0.01) compared with PDS group.…”

Section: Discussionsupporting

confidence: 45%

Patterns of Recurrence and Clinical Outcome of Patients With Stage IIIC to Stage IV Epithelial Ovarian Cancer in Complete Response After Primary Debulking Surgery Plus Chemotherapy or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery: An Italian Multicenter Retrospective Study

Gadducci¹,

Cosio²,

Zizioli³

et al. 2016

Int J Gynecol Cancer

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Section: Discussionsupporting

confidence: 45%

Patterns of Recurrence and Clinical Outcome of Patients With Stage IIIC to Stage IV Epithelial Ovarian Cancer in Complete Response After Primary Debulking Surgery Plus Chemotherapy or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery: An Italian Multicenter Retrospective Study

Gadducci¹,

Cosio²,

Zizioli³

et al. 2016

Int J Gynecol Cancer

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“…Three retrospective trials [ 12 – 15 ] also demonstrated that patients in the NACT-IDS group had a higher risk of platinum-resistant recurrence than those who underwent PDS. However, in studies by Rauh-Hain [ 12 ] and da Costa, [ 13 ] no significant difference in platinum-resistant disease at the first relapse was observed, whereas the risk of platinum-resistant disease at the second relapse was higher in both Rauh-Hain's (adjusted OR 4.06, P = 0.001) and da Costa's (adjusted HR 1.92, P = 0.009) studies. Moreover, in Petrillo's and Rauh-Hain's studies, [ 14 ] there was a significant difference in platinum-resistant disease at first recurrence only in the univariate analysis.…”

Section: Discussionmentioning

confidence: 97%

Effect of neoadjuvant chemotherapy on platinum resistance in stage IIIC and IV epithelial ovarian cancer

et al. 2016

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It remains controversial whether neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) induces chemoresistance in advanced epithelial ovarian cancer (EOC) compared with primary debulking surgery (PDS). The aim of this study was to compare platinum-resistant recurrence following treatment with NACT-IDS or PDS in patients with stage IIIC and IV EOC.We retrospectively reviewed the records of 341 patients who underwent PDS or NACT-IDS for Federation of Gynecology and Obstetrics stage IIIC or IV EOC between March 1990 and December 2010. Risk factors of platinum resistance, including NACT, postoperative residual tumor size, and various clinicopathological factors, were evaluated by univariate and multivariate logistic regression analyses. Survival analysis was performed by the Kaplan–Meier method and Cox regression modeling to measure overall survival (OS).Of 341 patients, 58 (17.0%) underwent NACT-IDS and 283 (83.0%) were treated with PDS. Twenty-nine (50.0%) patients developed platinum-resistant disease at first relapse after NACT-IDS and 99 (35.0%) patients recurred after PDS (P = 0.033). In the multivariate logistic regression analyses, NACT-IDS and postoperative residual tumor mass >1 cm were risk factors for platinum-resistant recurrence (adjusted odds ratios 2.950 and 2.915; 95% confidence intervals [CIs] 1.572–5.537 and 1.780–4.771, P = 0.001 and 0.000, respectively). Postoperative residual tumor mass >1 cm and platinum-resistant disease were significantly correlated with shorter OS (adjusted hazard ratios 1.579 and 4.078; 95% CI 1.193–2.089 and 3.074–5.412, P = 0.001 and 0.000, respectively), whereas NACT-IDS did not extend OS.NACT-IDS increases the risk of platinum-resistant recurrence in patients with stage IIIC and IV EOC.

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“…In particular, different retrospective series suggested a strong association between tumor volume, suboptimal cytoreduction and NACT + IDS with platinum resistance. 24 , 25 , 26 The most widely accepted hypothesis implicates the outgrowth of resistant clones, which are usually present at low rates before initial treatment and are greater in large tumor volumes treated with platinum compounds. 27 …”

Section: Discussionmentioning

confidence: 99%

Primary debulking surgery versus primary neoadjuvant chemotherapy for high grade advanced stage ovarian cancer: comparison of survivals

Kobal

Noventa

Cvjetičanin

et al. 2018

Radiology and Oncology

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BackgroundThe aim of the study was to analyze the overall survival (OS) and progression free survival (PFS) of patients with high grade and advanced stage epithelial ovarian cancer (EOC) with at least 60 months of follow-up treated in a single gynecologic oncology institute. We compared primary debulking surgery (PDS) versus neoadjuvant chemotherapy plus interval debulking surgery (NACT + IDS) stratifying data based on residual disease with the intent to identify the rationale for therapeutic option decision and the role of laparoscopic evaluation of resectability for that intention.Patients and methodsThis is observational retrospective study on consecutive patients with diagnosis of high grade and International Federation of Gynecology and Obstetrics (FIGO) stage III/IV EOC referred to our center between January 2008 and May 2012. We selected only patients with a follow-up of at least 60 months. Primary endpoint was to compare PDS versus NACT + IDS in term of progression free survival (PFS) and overall survival (OS). Secondary endpoints were PFS and OS stratifying data according to residual disease after surgery in patients receiving PDS versus NACT + IDS. Finally, through Cox hazards models, we tested the prognostic value of different variables (patient age at diagnosis, residual disease after debulking, American Society of Anesthesiologists (ASA) stage, number of adjuvant-chemotherapy cycles) for predicting OS.ResultsA total number of 157 patients were included in data analysis. Comparing PDS arm (108 patients) and NACT + IDS arm (49 patients) we found no significant differences in term of OS (41.3 versus 34.5 months, respectively) and PFS (17.3 versus 18.3 months, respectively). According to residual disease we found no significant differences in term of OS between NACT + IDS patients with residual disease = 0 and PDS patients with residual disease = 0 or residual disease = 1, as well as no significant differences in PFS were found comparing NACT + IDS patients with residual disease = 0 and PDS patients with residual disease = 0; contrarily, median PFS resulted significantly lower in PDS patients receiving optimal debulking (residual disease = 1) in comparison to NACT + IDS patients receiving complete debulking (residual disease = 0). PDS arm was affected by a significant higher rate of severe post-operative complications (grade 3 and 4). Diagnostic laparoscopy before surgery was significantly associated with complete debulking.ConclusionsWe confirm previous findings concerning the non-superiority of NACT + IDS compared to PDS for the treatment of EOC, even if NACT + IDS treatment was associated with significant lower rate of post-operative complications. On the other hand, selecting patients for NACT + IDS, based on laparoscopic evaluation of resectabilty prolongs the PFS and does not worse the OS compared to the patients not completely debulked with PDS.

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Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery and the Risk of Platinum Resistance in Epithelial Ovarian Cancer

Abstract: IDS correlates with a higher risk of the development of platinum resistance.

Cited by 43 publications

References 24 publications

Patterns of Recurrence and Clinical Outcome of Patients With Stage IIIC to Stage IV Epithelial Ovarian Cancer in Complete Response After Primary Debulking Surgery Plus Chemotherapy or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery: An Italian Multicenter Retrospective Study

Patterns of Recurrence and Clinical Outcome of Patients With Stage IIIC to Stage IV Epithelial Ovarian Cancer in Complete Response After Primary Debulking Surgery Plus Chemotherapy or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery: An Italian Multicenter Retrospective Study

Effect of neoadjuvant chemotherapy on platinum resistance in stage IIIC and IV epithelial ovarian cancer

Primary debulking surgery versus primary neoadjuvant chemotherapy for high grade advanced stage ovarian cancer: comparison of survivals

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