Quality of life in patients with advanced ovarian cancer after primary debulking surgery versus neoadjuvant chemotherapy: Results from the randomised SCORPION trial (NCT01461850)

Abstract

ObjectiveTo investigate the effect of treatment with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), versus primary debulking surgery (PDS), on quality of life (QoL) in patients with advanced epithelial ovarian cancer (EOC).DesignRandomised trial conducted in a single institution.SettingDivision of Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.SamplePatients with stage‐IIIC/IV EOC and high tumour load.MethodsPatients were randomised (1:1) to undergo either PDS (PDS group) or NACT followed by IDS (NACT/IDS group).Main outcome measuresQuality‐of‐life (QoL) data, assessed using the European Organization for Research and Treatment of Cancer core QoL questionnaire (QLQ‐C30) and ovarian cancer module (OV28); co‐primary outcomes were the QLQ‐C30 global health score at 12 months (cross‐sectional analysis) and the difference in mean QLQ‐C30 global health score over time between treatment groups (longitudinal analysis).ResultsFrom October 2011 to May 2016, 171 patients were enrolled (PDS = 84; NACT/IDS = 87). We observed no clinical or statistically significant difference between treatment groups in any of the QoL functioning scales at 12 months, including QLQ‐C30 global health score (NACT/IDS group vs PDS group, mean difference 4.7, 95% CI −4.99 to 14.4, p = 0.340). Over time, we found lower global health scores for those undergoing PDS than for those receiving NACT (difference in mean score 6.27, 95% CI 0.440–12.11, p = 0.035), albeit this was not clinically relevant.ConclusionsWe found no difference in global QoL related to treatment approach at 12 months, even though patients in the NACT/IDS group reported better global health scores across the 12‐month period compared with the PDS group; these findings further confirm that NACT/IDS might be a feasible option for patients unsuitable for PDS.

Prognostic Significance of Preoperative Inflammation Markers on the Long-Term Outcomes in Peritoneal Carcinomatosis from Ovarian Cancer

“…In the current paper, we aimed to analyse the possible correlations between preoperative levels of CA125, preoperative systemic inflammation, the extent of the disease and long-term outcomes of advanced-stage ovarian cancer. As mentioned before, the levels of CA125 cannot be considered as a gold standard in order to identify ovarian cancer patients and to predict long-term outcomes [4][5][6]; therefore, attention was focused on identifying other prognostic markers which might provide an adequate identification of cases who could benefit most from debulking surgery followed by adjuvant chemotherapy or, oppositely, who could better benefit from neoadjuvant therapy followed be interval debulking surgery [10][11][12]. One of the most commonly cited prognostic factors which has been recently investigated in patients suffering from malignant diseases is represented by the inflammatory status of each patient.…”

Survival impact and safety of intrathoracic and abdominopelvic cytoreductive surgery in advanced ovarian cancer: a systematic review and meta-analysis

“…In addition, Vizzielli et al calculated a simple adjusted laparoscopic score to predict major postoperative complications after PDS, which could help surgeons adopt tailored strategies on an individual basis (17). In addition, a number of randomized trials which compared survival outcomes of neoadjuvant chemotherapy (NACT) and PDS suggested that survival outcomes in neoadjuvant chemotherapy followed by interval debulking surgery (IDS) was not inferior to PDS followed by chemotherapy with no significant difference in global quality-of-life (QoL) (18)(19)(20)(21). Considering these findings, NACT or PDS should be carefully selected, and maximal effort at performing cytoreduction both in the intrathoracic and abdominopelvic tract may improve survival outcomes.…”

Why prevention offers an opportunity to reduce health inequities

“…However, in the primary surgery group there was a significantly higher likelihood of bowel resection, stoma, post operative complications and prolonged hospital stay. Since any of these can impact short‐ and long‐term quality of life, they must be taken into consideration when planning treatment (3). In a similar vein, Van Oudhesen et al investigated the efficacy of a laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse and showed that both are effective treatments for up to 12 months post‐surgery.…”