1013 - Predicting Factors of Secondary Resection after Neoadjuvant Chemotherapy in Locally Advanced Epithelial Ovarian Cancers. a Retrospective Study of 82 Cases

Abstract

ABSTRACT Objective The aims of our study were to assess the rate of optimal interval debulking surgery (IDS) and the potential predictors of chemotherapy responsiveness in patients treated with neoadjuvant chemotherapy(NACT). Methods We present a retrospective study including 82 EOC cases (stage IIIC or IV) collected in the medical oncology department of Farhat Hached Hospital-Sousse (Tunisia) during a period of 9 years (from 2002 to 2010). All patients received NACT followed by a clinical, radiological and biological assessment. Results The mean age of our patients was 54.5 years (27-80 years). Stage IIIC represented 69.5% of all cases and stage IV 30.5% (8 cases with pleural metastases, 14 cases with liver metastases, and 3 with pleural and liver metastases). CA-125 serum level was normal in only 7 cases. All patients received a mean number of 5 cycles of platinum-based NACT associated with paclitaxel in 78% of cases. Twenty seven patients achieved complete clinical response (CCR), 28 a partial clinical response (PCR) and 17 cases have disease progression. In 46/82 pts(56%), serum CA-125 was normalized after NACT. Ten patients achieved a radiological CR. Radiological PR was noted in 44 cases, while 19 patients had radiological disease progression. The rate of secondary resection was 51% (61.4% for stage IIIC and 28% for stage IV). Thirty one patients (74%) had an optimal IDS. We observed 9 pathological complete responses (pCR). Secondary optimal resection was significantly correlated to CA-125 serum level at the end of NACT (p = 0.001) and the quality of radiological response (CR or PR) (p = 0.001). Overall survival was 28.4 months, significantly better in cases of clinical or radiological complete response(p = 0.001) and in patients with optimal IDS (p = 0.01). pCR was associated with higher survival but without significant value (p = 0.08). In multivariate analysis, the parameters predicting a prolonged survival were: radiological complete or partial response (p = 0.05), optimal surgery (p = 0.001) and pCR (p = 0.03). Conclusion In initially unresectable EOC, NACT platinum-based chemotherapy followed by IDS is a therapeutic alternative leading to a higher rate of optimal surgery with an improvement of survival. Pre-operative CA-125 serum level as well as the radiological response appeared to be good predictors of secondary R0 surgery and tumor chemosensitivity. Disclosure All authors have declared no conflicts of interest.