Current Oncology Reports

, 11:457

Contemporary considerations for neoadjuvant chemotherapy in primary ovarian cancer

Article
  • 65 Downloads

Abstract

Surgery is essential for the successful treatment of patients with advanced ovarian cancer. Recent reports have raised questions about the best time to perform surgery with regard to administering chemotherapy. A prospective randomized clinical trial comparing neoadjuvant chemotherapy (ie, platinum-based chemotherapy before attempting cytoreductive surgery) and conventional treatment (ie, aggressive cytoreductive surgery followed by platinum-based chemotherapy) demonstrated no difference in progression-free and overall survival between the two treatment groups. The trial demonstrated the need for optimum surgical cytoreduction regardless of whether surgery is performed before or after neoadjuvant chemotherapy. As the postoperative morbidity and mortality was lower in the neoadjuvant treatment group, neoadjuvant chemotherapy should be considered a standard treatment for women with advanced ovarian cancer, particularly those unlikely to be surgically cytoreduced to no residual tumor. This article reviews contemporary considerations in the use of neoadjuvant chemotherapy in the treatment of primary ovarian cancer.

References and Recommended Reading

  1. 1.
    Schwartz PE: Neoadjuvant chemotherapy for the management of ovarian cancer. Oncol 2008, 22:1118–1125.Google Scholar
  2. 2.
    Chambers JT, Chambers SK, Voynick IM, et al.: Neoadjuvant chemotherapy in stage X ovarian carcinoma. Gynecol Oncol 1990, 37:327–331.CrossRefPubMedGoogle Scholar
  3. 3.
    Nelson BE, Rosenfield AT, Schwartz PE: Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol 1993, 11:166–172.PubMedGoogle Scholar
  4. 4.
    Pecorelli S, Odicino F, Favalli G: Interval debulking surgery in advanced ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2002, 16:573–583.CrossRefPubMedGoogle Scholar
  5. 5.
    Griffiths CT: Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Mongr 1975, 421:101–104.Google Scholar
  6. 6.
    Griffiths CT, Parker LM, Fuller HFR Jr: Role of cytoreductive surgical treatment in the management of advanced ovarian cancer. Cancer Treat Rep 1979, 63:235–240.PubMedGoogle Scholar
  7. 7.
    Hoskins WSJ, Bondy NB, Thigpen JD, et al.: The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 1992, 47:159–166.CrossRefPubMedGoogle Scholar
  8. 8.
    Crawford SC, Vasey PA, Paul J, et al.: Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from and international comparison within the SCOTROC-1 trial. J Clin Oncol 2005, 23:8802–8811.CrossRefPubMedGoogle Scholar
  9. 9.
    Crawford SC, Paul J, Kaye SA, et al.: Aggressive surgery and ovarian cancer. J Clin Oncol 2006, 24:2396.CrossRefGoogle Scholar
  10. 10.
    Winters WE III, Maxell GL, Tian C, et al.: Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2007, 25:3621–3627.CrossRefGoogle Scholar
  11. 11.
    Winters WE III, Maxell GL, Tian C, et al.: Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2008, 26:83–89.CrossRefGoogle Scholar
  12. 12.
    DuBois A, Reuss A, Pujade-Lauraine E, et al.: Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials. Cancer 2009, 115:1234–1244.CrossRefGoogle Scholar
  13. 13.
    McGuire WP, Hoskins WJ, Brady MF, et al.: Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996, 334:1–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Jemal A, Siegel R, Ward E, et al.: Cancer statistics 2008. CA Cancer J Clin 2008, 58:71–96.CrossRefPubMedGoogle Scholar
  15. 15.
    Wils J, Blijham, Naus A, et al.: Primary or delayed debulking surgery and chemotherapy consisting of cisplatin, doxorubicin and cyclophosphamide in stage III–IV epithelial ovarian carcinoma. J Clin Oncol 1986, 4:1068–1073.PubMedGoogle Scholar
  16. 16.
    Neijt JP, ten Bokkel Huinink WW, van der Burg ML, et al.: Randomized trial comparing two combination chemotherapy regimens (CHAP-5 v CP) in advanced ovarian carcinoma. J Clin Oncol 1987, 5:1157–1158.PubMedGoogle Scholar
  17. 17.
    Lawton F, Luesley D, Redman C, et al.: Feasibility and outcome of complete secondary tumor resection for patients with advanced ovarian cancer. J Surg Oncol 1990, 45:14–19.CrossRefPubMedGoogle Scholar
  18. 18.
    van der Burg MEL, van Lent M, Buyse M, et al.: The effect of debulking after induction chemotherapy on the prognosis of advanced epithelial ovarian cancer. N Engl J Med 1995, 332:629–634.CrossRefPubMedGoogle Scholar
  19. 19.
    Rose PG, Nerenstone S, Brady MF, et al.: Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 2004, 351:2489–2497.CrossRefPubMedGoogle Scholar
  20. 20.
    Bristow RE, Chi DS: Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis. Gynecol Oncol 2006, 103:1070–1076.CrossRefPubMedGoogle Scholar
  21. 21.
    Bristow RE, Eisenhauer EL, Santillan A, et al.: Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction. Gynecol Oncol 2007, 104:480–490.CrossRefPubMedGoogle Scholar
  22. 22.
    Hue JY, Kelly MG, Yu H, et al.: Neoadjuvant chemotherapy lessens surgical morbidity in advanced ovarian cancer and leads to improved survival in stage IV disease. Gynecol Oncol 2007, 105:211–217.CrossRefGoogle Scholar
  23. 23.
    Schwartz PE, Chambers JT, Makuch R: Neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol 1994, 53:33–37.CrossRefPubMedGoogle Scholar
  24. 24.
    Surwit E, Childers J, Atlas I, et al.: Neoadjuvant chemotherapy for advanced ovarian cancer. Int J Gynecol Cancer 1996, 6:356–361.CrossRefGoogle Scholar
  25. 25.
    Schwartz PE, Rutherford TJ, Chambers JT, et al.: Neoadjuvant chemotherapy for advanced ovarian cancer: long-term survival. Gynecol Oncol 1999, 72:93–99.CrossRefPubMedGoogle Scholar
  26. 26.
    Kang S, Nam BH: Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer?: meta-analysis of 21 studies. Ann Surg Oncol 2009 (in press).Google Scholar
  27. 27.
    Vergote I, Trope CG, Amant F, et al.: EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC-IV ovarian, fallopian tube, and peritoneal cancer (OVCA). Presented at the 12th Biennial Meeting of the International Gynecologic Cancer Society. Bangkok, Thailand; October 25, 2008.Google Scholar
  28. 28.
    Onda T, Kobayashi H, Nakanish T, et al.: Feasibility study of neoadjuvant chemotherapy followed by interval debulking surgery for stage III/IV ovarian, tubal and peritoneal cancers: Japan Clinical Oncology Group Study JCOG 0206. Gynecol Oncol 2009, 113:57–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Qayyum A, Coakley FV, Westphalen AC, et al.: Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer. Gynecol Oncol 2005, 96:301–306.CrossRefPubMedGoogle Scholar
  30. 30.
    Dowdy S, Mullany S, Brandt K, et al.: The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer 2004, 101:346–352.CrossRefPubMedGoogle Scholar
  31. 31.
    Axtell AE, Lee MH, Bristow RE, et al.: Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol 2007, 25:384–389.CrossRefPubMedGoogle Scholar
  32. 32.
    Aletti GO, Dowdy SC, Gostout BS, et al.: Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 2006, 107:77–85.PubMedGoogle Scholar
  33. 33.
    Chi DS, Ven Ktraman ES, Masson V, et al.: The ability of preoperative serum CA125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol 2000, 77:227–231.CrossRefPubMedGoogle Scholar
  34. 34.
    Obeidat B, Latimer J, Crawford R: Can optimal cytoreduction be predicted in advanced stage epithelial ovarian cancer? Role of preoperative serum CA125 level. Gynecol Obstet Invest 2004, 57:153–156.CrossRefPubMedGoogle Scholar
  35. 35.
    Gemer O, Lurain M, Goalevich M, et al.: A multicenter study of CA125 as a predictor of non-optimal primary cytoreduction of advanced epithelial ovarian cancer. Eur J Surg Oncol 2005, 31:1006–1010.CrossRefPubMedGoogle Scholar
  36. 36.
    Chi DS, Franklin CC, Levine DA, et al.: Improved optimal cytoreduction rates for stage IIIC and IV epithelial ovarian, fallopian tube, primary peritoneal cancer: a change in surgical approach. Gynecol Oncol 2004, 94:650–654.CrossRefPubMedGoogle Scholar
  37. 37.
    Deffieux C, Castaigne D, Pomel C: Role of laparoscopy to evaluated candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer. Int J Gynecol Cancer 2006, 16:35–40.CrossRefPubMedGoogle Scholar
  38. 38.
    Fagotti A, Ferrandina G, Fanfani F, et al.: A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol 2006, 13:1156–1161.CrossRefPubMedGoogle Scholar
  39. 39.
    Geisler JP, Linnemeier GC, Thomas AJ, et al.: Nutritional assessment using prealbumin as an objective criterion to determine whom should not undergo primary radical cytoreductive surgery for ovarian cancer. Gynecol Oncol 2007, 106:128–131.CrossRefPubMedGoogle Scholar
  40. 40.
    Schwartz PE, Zheng W: Neoadjuvant chemotherapy for advanced ovarian cancer: the role of cytology in pretreatment diagnosis. Gynecol Oncol 2003, 90:644–650.CrossRefPubMedGoogle Scholar
  41. 41.
    Dodge JE, Mackay H, Klachook S, et al.: What is the optimal strategy to confirm the diagnosis of epithelial ovarian carcinoma (EOC) prior to neoadjuvant chemotherapy (NAC)? J Clin Oncol 2009, 27:279S.CrossRefGoogle Scholar
  42. 42.
    Columbo P-E, Mourregot A, Fabbaro, et al.: Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. EJSO 2009, 35:135–143.Google Scholar
  43. 43.
    Armstrong DK, Bundy B, Wenzel L, et al.: Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006, 354:34–43.CrossRefPubMedGoogle Scholar
  44. 44.
    Vergote I, De WI, Tjalma W, et al.: Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol 1998, 71:431–436.CrossRefPubMedGoogle Scholar
  45. 45.
    Raffi A, Deval B, Geay J-F, et al.: Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy: a retrospective study. Int J Gynecol Cancer 2007, 17:777–783.CrossRefGoogle Scholar
  46. 46.
    Zamagni C, DeIaco P, Rosati M, et al.: Effect of six courses of neoadjuvant chemotherapy on pathological complete remission in advanced ovarian cancer. J Clin Oncol 2009, 27:280S.Google Scholar
  47. 47.
    Gasowska-Bodner A, Bodnar L, Benedykt WG, et al.: CA125 regression after two cycles of neoadjuvant chemotherapy as prognostic factor in patients with advanced ovarian cancer and primary peritoneal serous cancer who underwent interval surgical cytoreduction. Ginekol Polska 2008, 79:108–114.Google Scholar
  48. 48.
    Bland AE, Everett EN, Pastore WA, et al.: Predictors of suboptimal surgical cytoreduction in women with advanced epithelial ovarian cancer treated with initial chemotherapy. Int J Gynecol Cancer 2008, 18:629–636.CrossRefPubMedGoogle Scholar
  49. 49.
    de Jong D, Dodge JE, Freedman O, et al.: Predictors for optimal cytoreduction following neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma. J Clin Oncol 2009, 27:280S.Google Scholar
  50. 50.
    Tiersten AD, Liu PY, Smith HO, et al.: Phase II evaluation of neoadjuvant chemotherapy and debulking followed by intraperitoneal chemotherapy in women with stage III and IV epithelial ovarian, fallopian tube or primary peritoneal cancer: Southwest Oncology Group study S0009. Gynecol Oncol 2009, 112:444–449.CrossRefPubMedGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Department of ObstetricsGynecology and Reproductive SciencesNew HavenUSA

Personalised recommendations