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

Abstract

NAC followed by IDS provides equal survival compared with PDS. Debulking to small residual tumors with a maximum diameter of less than 1 cm provides a smaller but still significant benefit for patients with PDS but a relatively minor effect with IDS following NAC. To improve the survival of patients with advanced ovarian cancer, the definition of "optimal" in IDS following NAC should be defined as no residual tumor.

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

“…Subsequently, 11 studies were excluded in which the FIGO stages were III and IV [3, 13-20] or chemotherapies were administered intraperitoneally [21, 22]. Eventually, 12 studies were included in this meta-analysis, comprising 1 RCT [4], 9 cohort studies [1, 11, 23-29], and 2 case-control studies [5, 30]. The flow diagram of study selection is shown in Figure 1.…”

“…Out of the 12 studies, 5 studies were arranged with a total of 6 chemotherapeutic cycles [1, 4, 5, 23, 25], including 1,606 patients, with 705 for NAC and 901 for PDS. The characteristics of trials included in this systematic review and meta-analysis are summarized in Table 1.…”

“…Although under the impact of the huge selection biases, most of the studies proved that NAC followed by IDS could reduce the operation time, lessen the amount of blood loss, shorten the postoperative stay time, and even reduce the postoperative adverse reactions. However, controversy still existed regarding the survival outcomes of the groups [4, 5, 11, 23-30]. Therefore, it is still unclear which kind of patients can benefit more from NAC followed by IDS.…”

“…Therefore, for the current studies, NAC followed by IDS was still chosen for older patients with more comorbidities, poorer performance status, and later FIGO stage compared with PDS followed by chemotherapy [1, 3-5, 9-16, 18-20, 23-30]. Although under the impact of the huge selection biases, most of the studies proved that NAC followed by IDS could reduce the operation time, lessen the amount of blood loss, shorten the postoperative stay time, and even reduce the postoperative adverse reactions.…”

Neoadjuvant, adjuvant and long-term intravenous/intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy for ovarian cancer

“…114 and 225 patients underwent NACT followed by IDS and PDS, respectively. 26 No difference was observed in progression-free survival (PFS) or overall survival (OS) between NACT group and PDS group (PFS: 11 vs 10 months, P=0.629; OS: 25 vs 25 months, P=0.992). The investigators concluded that NACT followed by IDS provides equal survival compared to PDS.…”