Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma

Hegazy, Mohamed A.; Hegazi, Refaat; Elshafei, Mohamed A; Setit, Ahmed; Elshamy, Maged; Eltatoongy, Mohamed; Halim, Amal

doi:10.1186/1477-7819-3-57

Cited by 49 publications

(13 citation statements)

References 34 publications

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“…There were no postoperative deaths in our study. Results similar to,[ 11 12 13 ] and contradicting[ 14 15 ] our study have been reported. This study suffers from a small sample size, which might be the reason behind its failure to capture the difference in the postoperative complications; however its prospective design eliminates the biases associated with retrospective studies.…”

Section: Discussionsupporting

confidence: 76%

A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India

Ahmad

Rajanbabu

Vijaykumar

et al. 2015

South Asian J Cancer

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Objectives:The objective was to compare perioperative morbidity and mortality of patients with advanced epithelial ovarian cancer (EOC) treated with either of the two treatment approaches; neoadjuvant chemotherapy (NACT) followed by interval debulking versus upfront surgery.Design:Prospective comparative observational study.Participants:In total, 51 patients were included in the study. All patients with diagnosed advanced EOC (International Federation of Gynecology and Obstetrics IIIC and IV) presenting for the 1st time were included in the study.Interventions:Patients were either operated upfront (n = 19) if deemed operable or were subjected to NACT followed by interval debulking (n = 32).Primary and Secondary Outcomes:Intra- and postoperative morbidity and mortality were the primary outcome measures.Results:Patients with interval cytoreduction were noted to have significantly lesser operative time, blood loss, and extent of surgery. Their discharge time was also significantly earlier. However, they did not differ from the other group vis. a vis. postoperative complications or mortality.Conclusions:Neoadjuvant chemotherapy although has a positive impact on various intraoperative adverse events, fails to show any impact on immediate postoperative negative outcomes.

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Section: Discussionsupporting

confidence: 76%

A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India

Ahmad

Rajanbabu

Vijaykumar

et al. 2015

South Asian J Cancer

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“…Many studies have demonstrated a higher efficacy of surgery when combined with NAC for IDS [ 1 2 3 4 7 15 16 17 ]. The 5-year survival rate of patients without RD after IDS was comparable to that of patients with minimal RD (RD<2.0 cm) after PDS, however, the 5-year survival rate of patients with minimal RD (RD<2.0 cm) after IDS is worse (0%) [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Neoadjuvant chemotherapy (NAC) followed by surgical cytoreduction is a feasible approach for patients with advanced ovarian cancer. Previous reports of retrospective and non-randomized prospective studies [ 1 2 3 4 ] have demonstrated non-inferior survival with reduced serious morbidity in NAC-treated patients. Overall survival (OS) inversely correlates with residual tumor size or residual disease (RD) after primary debulking surgery (PDS) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer

et al. 2018

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ObjectiveOptimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS.MethodsIn total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS.ResultsNAC-treated patients had stage III–IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p<0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p<0.001).ConclusionPWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.

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“…Originally, NAC followed by an IDS was limited to patients who were poor surgical candidates or unlikely to be resected optimally [7, 9-12, 14-22, 25-29, 31-40]. However, the EORTC/NCIC trial showed the similar median OS (30.0 vs. 29.0 months) and median PFS (12 vs. 12 months) between the NAC group and PDS group, concluding that NAC followed by IDS was a reasonable treatment for advanced ovarian carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun

Xie

Wang

et al. 2017

Gynecol Obstet Invest

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Background/Aim: This study aimed to compare neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) with primary debulking surgery (PDS) followed by chemotherapy in patients with advanced ovarian carcinoma International Federation of Gynecology and Obstetrics (FIGO) stages IIIc and IV. Methods: PubMed, the Cochrane Library, and manual searches were applied to discriminate potentially eligible studies published before June 30, 2016. Results: A total of 12 comparative studies were finally included; 1,372 patients underwent NAC followed by IDS, and 2,680 patients underwent PDS followed by chemotherapy. For overall pooled estimates, significant between-trial differences were found in the optimal debulking rate, grade 3–5 postoperative adverse reactions, and median overall survival (OS), but no difference was found in the median progression-free survival (PFS). Moreover, a significantly higher incidence was identified in major infections, vascular events, and wound complications for patients in the PDS group. Conclusions: This study suggested that NAC followed by IDS could improve the optimal debulking rate and decrease the postoperative adverse reactions for the current studies, but whether it could improve the OS and PFS compared with PDS followed by chemotherapy in patients with ovarian carcinoma FIGO stages IIIc and IV were still needed to be verified by conducting more randomized controlled trials.

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Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma

Cited by 49 publications

References 34 publications

A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India

A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India

Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

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