Neoadjuvant Chemotherapy or Primary Debulking Surgery in Advanced Ovarian Carcinoma: A Retrospective Analysis of 285 Patients

Vergote, Ignace; Wever, Ivo De; Tjalma, Wiebren A.A.; Gramberen, Marleen Van; Decloedt, Jan; Dam, Peter van

doi:10.1006/gyno.1998.5213

Cited by 352 publications

(230 citation statements)

References 20 publications

Supporting

Mentioning

190

Contrasting

Unclassified

Order By: Relevance

“…Neoadjuvant chemotherapy (NACT) has been used in the treatment of advanced ovarian cancer as an alternative approach to conventional primary debulking surgery (Chambers et al, 1990;Vergote et al, 1998;Kayikc¸ioglu et al, 2001;Morice et al, 2003).…”

mentioning

confidence: 99%

Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?

et al. 2009

View full text Add to dashboard Cite

BACKGROUND: To investigate the value of neoadjuvant chemotherapy (NACT), followed by interval debulking surgery (IDS), in endometrial cancer with transperitoneal spread (stage IV). METHODS: Patients with endometrial cancer with transperitoneal spread, as determined by laparoscopy ( ± pleural effusion), were treated with NACT. Efficacy was determined according to the Response Evaluation Criteria in Solid Tumors, residual tumour at IDS and histopathological assessment of tumour regression. RESULTS: A total of 30 patients (median age: 65 years; range:44 -81 years) received 3 -4 cycles of NACT (83% paclitaxel/carboplatin). Histopathological subtypes were as follows: serous (90%), clear cell (3%) and endometrioid (6%) carcinoma. Response according to RECIST was as follows: 2 (7%) complete remission, 20 (67%) partial remission, 6 (20%) stable disease and 2 (7%) progressive disease (PD). Patients with PD were not operated upon. A total of 24 patients (80%) had optimal cytoreduction (R p1 cm), of whom 22 (92%) were without residual tumour. Four patients were considered inoperable and were excluded from further analysis. The median progression-free survival and overall survival times were 13 and 23 months, respectively. Histopathological features of chemoresponse in both uterus and omentum were related to a better PFS (P ¼ 0.017, hazard ratio (HR) ¼ 0.785) and overall survival (P ¼ 0.014, HR ¼ 0.707). In particular, the absence of tumour infiltration and necrosis were associated with prognosis. CONCLUSION: The use of NACT resulted in a high rate (80%) of optimal IDS for the treatment of endometrial cancer with transperitoneal spread.

show abstract

mentioning

confidence: 99%

Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Debulking after the receipt of neoadjuvant chemotherapy appears to be associated with less operative morbidity and improved rates of optimal cytoreduction. 6,[11][12][13][14][15] Chambers et al 11 in 1990 and Schwartz et al 13 in 1994 compared the outcomes of patients with clinical evidence of advanced-stage ovarian carcinoma treated with neoadjuvant chemotherapy with patients with suboptimally debulked Stage IIIC and Stage IV ovarian carcinoma who were later treated with chemotherapy. They found that the overall survival was the same for both groups of patients but that the patients who received neoadjuvant treatment better tolerated chemotherapy.…”

mentioning

confidence: 99%

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Dowdy

Mullany

Brandt

et al. 2004

Cancer

167

100

View full text Add to dashboard Cite

BACKGROUNDComputed tomography (CT) scans of the abdomen and pelvis may predict which patients with ovarian carcinoma can undergo optimal cytoreduction at primary surgery. Previous studies have demonstrated that patients with ovarian carcinoma had optimal cytoreduction rates ranging from 50–60%. The authors sought to determine whether these findings applied to a surgical practice with a higher rate of optimal debulking. A predictive model using CT scanning and CA 125 values would allow the authors to determine which patients would be more appropriately treated with neoadjuvant chemotherapy.METHODSPreoperative CT scans for patients with Stage III/IV ovarian carcinoma (according to the staging system of the International Federation of Gynecology and Obstetrics) who were treated between 1996 and 2001 were evaluated retrospectively by 2 radiologists for 17 criteria evaluating the extent of disease. Clinical data were extracted from medical records. Residual tumors measuring ≥ 1 cm were considered suboptimal. Logistic regression was used to evaluate which criteria correlated with optimal cytoreduction.RESULTSEighty‐seven patients were identified retrospectively who met entry criteria and had preoperative CT scans of sufficient diagnostic quality. Sixty‐two patients (71%) received optimal cytoreductive surgery and 45 (52%) required aggressive surgical procedures. In a multivariate model, only diffuse peritoneal thickening (DPT) independently predicted suboptimal surgical resection (P = 0.016). However, a model using both DPT and ascites on most CT scans had a positive predictive value of 68% and a sensitivity of 52% for predicting suboptimal cytoreduction.CONCLUSIONSThe presence of DPT and large‐volume ascites was associated with a very low rate of optimal cytoreduction (32%) in a surgical practice. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction. Cancer 2004. © 2004 American Cancer Society.

show abstract

“…The effect of NAC/IDS on survival and perioperative morbidity varies in these studies (4)(5)(6). According to these studies, patients treated with NAC/IDS had comparable survival with those who underwent PDS (5,(7)(8)(9).…”

Section: Original Articlementioning

confidence: 98%

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

Zheng

Gao

2012

Chin. J. Cancer Res.

View full text Add to dashboard Cite

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...

show abstract

Neoadjuvant Chemotherapy or Primary Debulking Surgery in Advanced Ovarian Carcinoma: A Retrospective Analysis of 285 Patients

Cited by 352 publications

References 20 publications

Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?

Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?

The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

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

Contact Info

Product

Resources

About