The role of neoadjuvant chemotherapy in patients with advanced (stage IIIC) epithelial ovarian cancer

Abstract

BackgroundPrimary treatment of patients with advanced epithelial ovarian cancer consists of chemotherapy either before (neoadjuvant chemotherapy, NACT) or after primary surgery (adjuvant chemotherapy). The goal of primary treatment is no residual disease after surgery (R0 resection) what is associated with an improvement in survival of patients. There is, however, no evidence of survival benefits in patients with R0 resections after prior NACT.MethodsWe retrospectively reviewed the records of patients who were treated with diagnosis of epithelial ovarian cancer at Institute of Oncology Ljubljana in the years 2005–2007. The differences in the rates of R0 resections, progression free survival (PFS), overall survival (OS) and in five-year and eight-year survival rates between patients treated with NACT and patients who had primary surgery were compared.ResultsOverall 160 patients had stage IIIC epithelial ovarian cancer. Eighty patients had NACT and eighty patients had primary surgery. Patients in NACT group had higher rates of R0 resection (42% vs. 20%; p = 0.011) than patients after primary surgery. PFS was 14.1 months in NACT group and 17.7 months after primary surgery (p = 0.213). OS was 24.8 months in NACT group and 31.6 months after primary surgery (p = 0.012). In patients with R0 resections five-year and eight-year survival rates were 20.6% and 17.6% in NACT group compared to 62.5% and 62.5% after primary surgery (p < 0.0001), respectively.ConclusionsDespite higher rates of R0 resections achieved by NACT, survival of patients treated with NACT was inferior to survival of patients who underwent primary surgery. NACT should only be offered to patients with advanced epithelial cancer who are not candidates for primary surgery.

The prognostic effect of residual tumor for advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy or primary debulking surgery

“…However, 68% of the respondents still believed that there was insufficient evidence to treat advanced EOC patients with NACT in the updated data of the survey from the SGO in 2016 20 . In addition to the publication of the CHORUS and EORTC 55971 outcomes, various factors including age, tumor stage, tumor size, and co‐morbidity may also impact the choice of NACT 21–24 …”

Potential of osteopontin in the management of epithelial ovarian cancer

“…In the management of advanced-stage EOC, it is essential to identify patients who are more eligible for NACT and IDS, since primary complete resection cannot be achieved. 18 , 19 , 28 , 29 Laparoscopy can be used as an adjuvant procedure to assess tumour spread and resectability. Laparoscopic evaluation, however, has limitations and may, in some cases, underestimate the extent of disease.…”

Reporting ‘Denominator’ data is essential for benchmarking and quality standards in ovarian cancer

“…Eighteen studies met the specified inclusion criteria (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) for the systematic search. Only two (11%) papers explicitly defined their total patient cohort (21,27).…”

“…Only two (11%) papers explicitly defined their total patient cohort (21,27). Two additional papers (11%) used terms which were ambiguous in relation to the total patient population (34,35).…”

“…No papers presented OS for the total patient cohort although one(21) did include nonoperated patients with their surgical study cohort. Two papers (11%) documented the number of patients who received any therapeutic treatment (21,27) with two papers (11%) ambiguous in their descriptions (34,35). Although twelve papers (67%) explicitly described all patients receiving surgery (21, 23-25, 27-30, 32, 34-36) only four papers (22.2%) published their OS of all surgically managed patients (24,(28)(29)(30).…”