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Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: An Institutional Experience

Abstract

Purpose

Epithelial ovarian cancer is the second most common gynaecological malignancy among Indian women. Primary debulking surgery remains the standard of care in advanced operable ovarian cancer patients, but is associated with morbidity. Neoadjuvant chemotherapy followed by delayed primary cytoreductive surgery may be a better treatment strategy in advanced ovarian cancer. We present our experience of neoadjuvant chemotherapy in advanced ovarian cancer with special emphasis on treatment outcomes.

Methods

A retrospective analysis of advanced epithelial ovarian carcinoma (stages III and IV) patients treated at the Department of Surgical Oncology at King George’s Medical University, Lucknow, between 2012 and 2016 was done.

Results

A total of 128 patients with advanced ovarian carcinoma were treated during this period. Median age at diagnosis was 46 years. Among these patients, 115 underwent surgery, of which 57.4% were optimally cytoreduced. Papillary serous adenocarcinoma was the most common histological subtype (78.1%). Recurrence was seen in 73% of patients, with a median time to recurrence 16 months (range 6.5–37 months). They were managed with second-line chemotherapy and surgery. Median overall survival in this study for optimally cytoreduced stage III patients was 38 months and 17 months for optimally cytoreduced stage IV patients. Median progression-free survival for stage III was 13 months and stage IV was 6 months.

Conclusion

Neoadjuvant chemotherapy facilitates surgery in advanced ovarian cancer and helps in assessing chemotherapy responsiveness. It provides an opportunity to modify systemic treatment if there is no response to therapy or disease progression.

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References

  1. Stewart BW, Wild CP, editors. World Cancer Report 2014. Lyon: International Agency for Research on Cancer; 2014.

    Google Scholar 

  2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Ovarian Cancer including Fallopian Tube Cancer/Primary Peritoneal Cancer (Version 3.2017). https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Accessed 2 Sept 2017.

  3. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975;42:101–4.

    CAS  PubMed  Google Scholar 

  4. Chi DS, Zivanovic O, Levinson KL, et al. The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal and peritoneal carcinomas. Gynecol Oncol. 2010;119(1):38–42.

    Article  Google Scholar 

  5. Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20(5):1248–59.

    Article  Google Scholar 

  6. Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a gynaecologic Oncology Group study. J Clin Oncol. 2003;21(17):3194–200 Epub 2003 Jul 14.

    CAS  Article  Google Scholar 

  7. Dauplat J, Le Bouëdec G, Pomel C, et al. Cytoreductive surgery for advanced stages of ovarian cancer. Semin Surg Oncol. 2000;19(1):42–8.

    CAS  Article  Google Scholar 

  8. Kang S, Nam BH. Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer? Meta-analysis of 21 studies. Ann Surg Oncol. 2009;16(8):2315–20.

    Article  Google Scholar 

  9. Vergote I, Tropé CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian Cancer. N Eng1 J Med. 2010;363(10):943–53.

    CAS  Article  Google Scholar 

  10. Morice P, Brehier-Ollice D, Rey A, et al. Results of Interval debulking surgery in advanced stage ovarian cancer: an exposed-non-exposed study. Ann Oncol. 2003;14(1):74–7.

    CAS  Article  Google Scholar 

  11. Rustin GJ, Quinn M, Thigpen T, et al. Re: new guidelines to evaluate the response to treatment in solid tumors (ovarian cancer). J Natl Cancer Inst. 2004;96(6):487–8.

    Article  Google Scholar 

  12. Hamed EO, Ahmed H, Sedeek OB, et al. Significance of HE4 estimation in comparison with CA 125 in diagnosis of ovarian cancer and assessment of treatment response. Diagn Pathol. 2013;8:11.

    CAS  Article  Google Scholar 

  13. Furukawa N, Sasaki Y, Shigemitsu A, et al. CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer. J Gynecol Oncol. 2013;24(2):141–5.

    CAS  Article  Google Scholar 

  14. Rodriguez N, Rauh-Hain JA, Shoni M, et al. Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2012;125(2):362–6.

    CAS  Article  Google Scholar 

  15. Kumar L, Hariprasad R, Kumar S, et al. Neoadjuvant chemotherapy in advanced epithelial ovarian cancer (EOC): a prospective, randomized study. Indian J Med Paediatr Oncol. 2009;30(5):15.

    Google Scholar 

  16. Kehoe S, Hook J, Nankiveli M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open label, randomised, controlled, non inferiority trial. Lancet. 2015;386(9990):249–57.

    Article  Google Scholar 

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Correspondence to Vijay Kumar.

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Lakshmanan, M., Kumar, V., Chaturvedi, A. et al. Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: An Institutional Experience. Indian J Gynecol Oncolog 17, 76 (2019). https://doi.org/10.1007/s40944-019-0322-1

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  • DOI: https://doi.org/10.1007/s40944-019-0322-1

Keywords

  • Neoadjuvant chemotherapy
  • Ovarian cancer
  • Interval cytoreduction
  • Gynaecologic malignancy
  • Recurrence