The Role of Induction Chemotherapy in Inoperable Ovarian Cancer

Abstract

Thirty patients with bulky advanced ovarian cancer surgically not resectable, received combination chemotherapy (median of 4.1 cycles; range, 3-7) including cisplatin or carboplatin, followed by a second surgical effort. Clinical CR + PR was observed in 24/30 (80%) patients after chemotherapy. Our study deals only with these 24 patients, and the 6 patients who did not respond to chemotherapy are not part of this report. At debulking, 7/24 (29.1%) patients had a complete macroscopic resection; 9/24 (37.5%) patients had a partial resection (residual tumor less than 2 cm). These data suggest that debulking is feasible and successful after chemotherapy containing cisplatin or its derivative. Overall median survival from diagnosis was 18.9 months; the 3-year survival rate was 28%. Median progression-free survival from diagnosis was 13.5 months. The results observed in our study indicate that the use of induction chemotherapy can play an important role in increasing the chances of optimal debulking in patients presenting with unresectable ovarian cancer.

Residual Cancer Stem Cells after Interval Cytoreductive Surgery following Neoadjuvant Chemotherapy Could Result in Poor Treatment Outcomes for Ovarian Cancer

“…However, a higher recurrence after complete remission with combined chemotherapy and cytoreductivesurgeryresultsinahighermortalityinthemanagementofovariancancer [32].Residualtumoraftercompletionofcytoreductivesurgeryisthemostimportantprognostic factorinthemanagementofovariancancer [3,4].Fromare- ResidualCancerStemCellsinOvarianCancer 327 irradiation,anddemonstratedthatinsomepatientstherewas sufficientregressiontoallowresectionatalaterdate.Donadioetal. [41]firstreportedtheresultsofneoadjuvantchemotherapy in patients who could not be debulked a priori, or who could not undergo primary surgery owing to medical problems,in1989.Thereweremanycriteria,suchasascites, CA-125, disease extent and sites, required surgeries for cytoreductive surgery, and general condition [42][43][44]. In 2004, the3rdInternationalGynecologicCancerIntergroupOvarian CancerConsensusConference(GCIGOCCC)suggestedthat neoadjuvantchemotherapycouldbeconsideredwhencytoreductive surgery is not possible initially [45].…”

The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer

“…This has the potential to overestimate the percentage of patients that achieve optimal cytoreductive status and also may overestimate the survival benefit [57,63,[70][71][72][73][74][75][76]. In a study by Brun et al [67], all patients that received NACT regardless of their response to chemotherapy underwent ICS.…”

“…Similar to Bristow and Chi [52], they studied patients with advanced stage ovarian cancer who received platinum-based chemotherapy prior to ICS. Unlike Bristow and Chi, they excluded studies that reported survival data among the NACT responders only and not the entire cohort of NACT patients [62,63,70,74]. Also, in contrast to Bristow and Chi, two studies were excluded because they did not report the exact median overall survival [47,89] and in one study, the authors performed NACT followed by second look operation only without ICS [90].…”

Timing of debulking surgery in advanced ovarian cancer

“…From several retrospective phase II studies, it appears that the outcome of these women, treated with neoadjuvant chemotherapy followed by interval debulking surgery, is essentially the same as for patients treated with primary debulking surgery followed by chemotherapy. These studies are summarized in Table 2 (21,36–59) . In most of these studies, interval debulking surgery was performed after three or four courses of neoadjuvant chemotherapy.…”

“…Table 1. Patient characteristics of the randomized EORTC (34) and GOG 152 (35) (36) 24 NAC increase the chances of optimal debulking Lawton et al (37) 36 78% IDS of which 89% ,2 cm Tummarello et al (38) 24 NAC could be a valid alternative to surgery Jacob et al (39) 22 Same survival as 18 matched controls Lim and Green (40) 30 NAC can make patients operable Shimizu and Hasumi (41) 74 46% IDS to ,2 cm…”