Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer

Mazzeo, F; Berlière, Martine; Kerger, Joseph; Squifflet, Jean‐Paul; Duck, Lionel; Humblet, Yves; Donnez, Jacques; Machiels, Jean‐Pascal

doi:10.1016/s0090-8258(03)00249-x

Cited by 89 publications

(57 citation statements)

References 19 publications

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“…The response of NAC in most patients was evaluated by serum CA125 level or physical examination. CA125 is a good surrogate marker for tumor response, and the patients with normalized CA125 after neoadjuvant chemotherapy had a better survival (21). In our small-sized study, normalized CA125 after NAC was not a prognostic factor of OS or PFS.…”

Section: Discussioncontrasting

confidence: 50%

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Zheng

Gao

2012

Chin. J. Cancer Res.

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Objectives: To compare the survival and perioperative morbidity between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NAC/IDS) in treating patients with advanced epithelial ovarian cancer (EOC). The optimal debulking rate was 60% in the NAC/IDS group, which was significantly higher than that in the PDS group (32.4%) (P=0.024). The NAC/IDS group had significantly less intraoperative estimated blood loss and transfusion, lower nasogastric intubation rate, and earlier ambulation and recovery of intestinal function than the PDS group (P<0.05).Conclusions: NAC/IDS is less invasive than PDS, and offers the advantages regarding optimal cytoreduction rate, intraoperative blood loss, and postoperative recovery, without significantly impairing the survival compared with PDS in treating patients with stage IIIC or IV EOC. Therefore, NAC/IDS may be a valuable treatment alternative for EOC patients. Neoadjuvant chemotherapy (NAC) is a chemotherapy method for primary solid tumors before surgical ablation. Ovarian cancer is a chemosensitive tumor with a response rate of 70% to 80% (3), thus, NAC can usually result in adequate tumor shrinkage and increase the possibility of optimal tumor debulking. Therefore, NAC followed by interval debulking surgery (NAC/IDS) has been considered as an alternative to conventional PDS in treating advanced EOC.In the last 20 years, over 30 studies regarding NAC in advanced ovarian cancer were conducted, most of which are retrospective in nature. The effect of NAC/IDS on survival and perioperative morbidity varies in these studies (4-6). According to these studies, patients treated with NAC/IDS had comparable survival with those who underwent PDS (5,(7)(8)(9).In the present study, we compared the survival and perioperative morbidity between patients with stage IIIC or IV EOC who were treated with PDS and NAC/IDS. Materials and methods Patients and treatmentWe retrospectively reviewed 67 patients diagnosed with stage IIIC or IV EOC who were treated at Peking University Cancer Hospital from January 2006 to June 2009. The study was approved by the Institutional Review Board. Thirtyseven patients received PDS and 30 underwent NAC/IDS. The diagnosis for the NAC-treated patients was based on laparoscopic biopsy (53%), ultrasound-guided biopsy (30%), or cytology (17%).NAC was given when optimal cytoreduction was considered infeasible by computerized tomography (CT) scan or when the patients were in poor conditions [Karnofsky Performance Scale (KPS) scores under 60]. NAC-treated patients usually presented a great amount of ascites, extensive bowel mesenteric involvement, or diffused peritoneal thickening, as indicated by CT scans.In the NAC/IDS group, most patients were given two courses of chemotherapy (83.3%) before the debulking surgery, whereas the others were given one course. Twentyfive patients received paclitaxel/carboplatin (CP), 4 received cyclophosphamide/doxorubicin/carboplatin (CAC), and 1 received cyclophosphamide/cisplatin as NAC regim...

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Section: Discussioncontrasting

confidence: 50%

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Zheng

Gao

2012

Chin. J. Cancer Res.

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“…Hence NACT may be helpful in achieving cytoreduction and converting possible suboptimal initial surgery into optimal surgery. Several studies [8,9,[11][12][13][14][15] have established the role of platinum based NACT in advanced stage ovarian cancer without compromising OS or PFS and offering better quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, neoadjuvant chemotherapy (NACT) has been advocated for patients with advanced ovarian cancer with an aim to improve resectability rates and survival [8]. In view of this many investigators have used primary or upfront NACT as an alternative to primary surgery with the goal of improving surgical quality.…”

Section: Introductionmentioning

confidence: 99%

Role of Neoadjuvant Chemotherapy (NACT) Followed by Surgical Cytoreduction in Advanced Epithelial Ovarian Cancer

Batra

Nayak

Dave

2012

J Obstet Gynecol India

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Objectives To study the role of neoadjuvant chemotherapy (NACT) followed by surgical cytoreduction in the management of advanced epithelial ovarian cancers. Methods A prospective hospital based study of patients with advanced epithelial ovarian cancers (stage III and IV) was conducted at Gujarat Cancer & Research Institute, Ahmedabad during August 2008 to August 2010. Total 50 patients were treated with NACT followed by surgical cytoreduction and followed up till August 2010. Response to NACT, optimal cytoreduction rate and overall response rate were analyzed. Results There were 43 patients (86%) with stage III disease and 7 (14%) with stage IV disease. All patients were given NACT and after NACT, complete response occurred in 17 patients (34%), 27 (54%) had partial response. Optimal surgical cytoreduction could be achieved in 36(72%) of the patients. The median follow up was 19 months.Conclusions NACT followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers.

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“…Platinum-based drugs are used for the treatment of a wide variety of solid tumors, including testicular, ovarian, bladder, colorectal and lung tumors (Mazzeo et al 2003). Cisplatin exerts anticancer effects via multiple mechanisms.…”

Section: Resultsmentioning

confidence: 99%

Extremely low frequency electromagnetic field sensitizes cisplatin-resistant human ovarian adenocarcinoma cells via P53 activation

2015

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In the following study, extremely low frequency electromagnetic fields (EL-EMF) radiation was used to restore sensitivity in the cisplatin-resistant A2780 ovarian cancer cells. For this purpose A2780 cells were treated with different doses of cisplatin and EL-EMF (50 Hz, 200 gauss, and 2 h) alone. Cytotoxicity was the measurement using MTT assay. After calculating IC 50 for cisplatin (90 lg/ml) a lower concentration from IC 50 (30 and 60 lg/ml) was used to be combined with EL-EMF. We compare the effects of each cisplatin, EL-EMF and combination groups using acridine orange-propidium iodide (AO/PI) and DAPI staining, caspase 3/9 activation assay and Annexin/PI assay. We also assessed changes in P53 and Matrix metalloproteinases 2 (MMPs) gene expression with semi-quantitative RT-PCR. Results indicated an EL-EMF-dependent proliferative decrease which was found \10 %, and occurred independently of cisplatin. The decreased proliferation rate for 30 and 60 lg/ml cisplatin was about 20 and 40 %, respectively, while for synergistic groups 30 and 60 lg/ml cisplatin with 2 h EL-EMF exposer, showed 47 and 71 % decrease in viability in rats. DAPI staining indicated that chromatin break down significantly increased in synergistic groups. Acridine orange staining also confirmed MTT assay results. Caspase activity significantly increased in the combined groups. Semi-quantitative RT-PCR showed that in synergistic groups of cisplatin and EL-EMF, expression of P53 was increased but the expression level of MPP-2 gene decreased. Results from this study showed that changes generated by the non-invasive EL-EMF can make resistant cells sensitive to cisplatin.

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Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer

Cited by 89 publications

References 19 publications

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Role of Neoadjuvant Chemotherapy (NACT) Followed by Surgical Cytoreduction in Advanced Epithelial Ovarian Cancer

Extremely low frequency electromagnetic field sensitizes cisplatin-resistant human ovarian adenocarcinoma cells via P53 activation

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