Primary Cytoreductive Surgery Versus Interval Debulking Surgery Following Neoadjuvant Chemotherapy in Epithelial Ovarian Cancer: An Institutional Review
- 3 Downloads
To compare the overall survival of women with advanced-stage EOC treated by PCS versus NACT followed by IDS.
Design, Setting, and Participants
Retrospective study of women with stage IIB–IVA ovarian carcinoma FIGO staging diagnosed between 2016 and 2018 treated at Department of Surgical Oncology, Sri Aurobindo Medical College and Post Graduate Institute, Indore.
Initial treatment approach of PCS versus NACT + IDS, examined using an intent-to-treat analysis.
The median follow-up was 18 months (10–36 months) in both groups. The median overall survival was 38 months in PCS group and 31 months in NACT group. Postoperative complications were seen more often in PCS group (11.3%) against 3.33% in NACT group. Patients with residual disease (microscopic and macroscopic residual disease) had poorer prognosis.
Primary cytoreductive surgery is associated with improved survival compared with NACT in otherwise healthy women with bulky epithelial ovarian. The biggest risk associated with the use of NACT is that patients with significant side effects and refractory disease will lose the opportunity for initial surgery. The lower survival in women receiving NACT can be owed to limited performance status in women undergoing NACT.
KeywordsEpithelial ovarian cancer (EOC) Primary cytoreductive surgery (PCS) Interval debulking surgery (IDS) Neoadjuvant chemotherapy (NACT)
Compliance with Ethical Standards
Conflict of interest
The authors have no potential conflict of interest to disclose.
- 1.Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer (IARC). 2013. https://doi.org/10.1002/ijc.29210.
- 4.Du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe D’Investigateurs Nationaux Pour Les Etudes Des Cancers De L’Ovaire (GINECO). Cancer. 2009;115:1234–44. https://doi.org/10.1016/s1040-1741(09)79358-3.CrossRefPubMedGoogle Scholar
- 7.Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2005;386(9990):249–57. https://doi.org/10.1016/s0140-6736(14)62223-6.CrossRefGoogle Scholar
- 10.Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Poynor EA, Aghajanian C, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC–IV epithelial ovarian cancer. Gynecol Oncol. 2006;103(3):1083–90. https://doi.org/10.1016/j.ygyno.2006.06.028.CrossRefPubMedGoogle Scholar
- 11.Hoskins WJ, Bundy BN, Thigpen JT, Omura GA. 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(2):159–66. https://doi.org/10.1016/0090-8258(92)90100-w.CrossRefPubMedGoogle Scholar
- 12.Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO, et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol. 2006;107(1):77–85. https://doi.org/10.1097/01.aog.0000192407.04428.bb.CrossRefPubMedGoogle Scholar
- 13.Chi DS, Eisenhauer EL, Zivanovic O, Sonoda Y, Abu-Rustum NR, Levine DA, et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol. 2009;114(1):26–31. https://doi.org/10.1016/j.ygyno.2009.03.018.CrossRefPubMedGoogle Scholar
- 14.Van Meurs HS, Tajik P, Hof MHP, Vergote I, Kenter GG, Mol BWJ, et al. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer. 2013;49(15):3191–201. https://doi.org/10.1016/j.ejca.2013.06.013.CrossRefPubMedGoogle Scholar
- 15.Chi DS, Musa F, Dao F, Zivanovic O, Sonoda Y, Leitao MM, et al. An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). Gynecol Oncol. 2012;124(1):10–4. https://doi.org/10.1016/j.ygyno.2011.08.014.CrossRefPubMedGoogle Scholar
- 16.Fagotti A, De Iaco P, Fanfani F, Vizzielli G, Perelli F, Pozzati F, et al. Systematic pelvic and aortic lymphadenectomy in advanced ovarian cancer patients at the time of interval debulking surgery: a double-institution case-control study. Ann Surg Oncol. 2012;19(11):3522–7. https://doi.org/10.1245/s10434-012-2400-9.CrossRefPubMedGoogle Scholar
- 18.Glasgow MA, Yu H, Rutherford TJ, Azodi M, Silasi D-A, Santin AD, et al. Neoadjuvant chemotherapy (NACT) is an effective way of managing elderly women with advanced stage ovarian cancer (FIGO Stage IIIC and IV). J Surg Oncol. 2012;107(2):195–200. https://doi.org/10.1002/jso.23171.CrossRefPubMedGoogle Scholar