Comparing the Effectiveness of the Treatment with Neoadjuvant Chemotherapy Followed By Interval Debulking and Primary Debulking Followed By Adjuvant Chemotherapy in Advanced Stage Malignant Ovarian Tumors: A Rural Based Study

Abstract

Background: Advanced epithelial ovarian cancer is also a poorly prognosed condition with elevated death rate The management of advanced ovarian carcinoma is surgical debulking which is followed by adjuvant chemotherapy. Prognosis reflects primarily on the level of cytoreduction obtained in primary surgery. In order to enhance survival, attempts are therefore being made to increase the optimal rates of surgical cytoreduction. NACT has emerged as an important treatment modality. The reasoning behind the NACT protocol is to make advanced untreatable disease operable, increase resection rates of optimal cyto reduction (R0) and promote organ preservation. The application of neo adjuvant chemotherapy will structurally reduce the load of the tumour because of the chemo sensitive nature of the ovarian tissue and enable a greater optimal cytoreduction rate for surgery and an increase in overall survival.
 Methods: This observational and retrospective study was conducted from 2018-2020, including 71 patients who visited the oncology clinic of OBGY department at AVBRH. Only those who have already diagnosed as stage III and IV ovarian neoplasms and who received primary debulking surgery followed by adjuvant chemotherapy along with neo adjuvant chemotherapy followed by interval de-bulking surgery were included to study the better treatment outcome in terms of intra-operative and post-operative complications and over all and survival without progression in these patients with a follow-up of 2 years.
 Results: The statistical difference in ooverall survival and progression free survival between primary debulking and NAC / IDS groups was >0.005.But intra operative findings like blood loss, residual disease. Bowel bladder injury, surgery time & post-operative morbidity were less in NAC/IDS group with P value <0.005.
 Conclusion: In patients having cytoreducible disease which is non optimal or low performance status, NAC / IDS is also a reasonably secure and may be an alternative method for achieving optimal cytoreduction. Investigations aimed at appropriately selecting patients to be treated with NAC and to search for the proper opportunity to conduct IDS can have much better benefits for patients having advanced EOC. It should be underscored that the study is limited to patients with stage 3c or 4 disease.