Abstract
BackgroundThere is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer. The aim of this study was to compare the impact of the adjuvant and neoadjuvant chemotherapy regimens on the clinical outcomes in patients with advanced ovarian cancer.MethodsWe performed a retrospective analysis of 574 patients with advanced ovarian cancer admitted to four Lithuanian oncogynaecology departments during 1993–2000. The conventional combined treatment of cytoreductive surgery and platinum-based chemotherapy was applied to both the group that underwent neoadjuvant chemotherapy (n = 213) and to the control group (n = 361). The selection criterion for neoadjuvant chemotherapy was large extent of the disease. Overall and progression-free survival rates and survival medians were calculated using life tables and the Kaplan-Meier method.ResultsThere was no difference in median overall survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (25.9 months vs. 29.3 months, p = 0.2508) and stage IV patients (15.4 months vs. 14.9 months, p = 0.6108). Similarly, there was no difference in median progression-free survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (15.7 months vs. 17.5 months, p = 0.1299) and stage IV patients (8.7 months vs. 8.2 months, p = 0.1817). There was no difference in the rate of the optimal cytoreductive surgery between patients who underwent the neoadjuvant chemotherapy and patients primarily treated with surgery (n = 134, 63% vs. n = 242, 67%, respectively).ConclusionThere was no difference in progression-free or overall survival and in the rate of optimal cytoreductive surgery between the neoadjuvant and adjuvant chemotherapy groups despite the fact that patients receiving neoadjuvant chemotherapy had a more extensive disease. Multivariate analysis failed to prove that neoadjuvant chemotherapy could be considered as an independent prognostic factor for survival, and the findings need to be investigated in the future prospective randomised studies.
Highlights
There is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer
The aim of this study was to evaluate the role of neoadjuvant chemotherapy in the management of advanced ovarian cancer compared to adjuvant chemotherapy, and to determine the impact of the neoadjuvant chemotherapy on the optimisation of cytoreductive surgery
In the group of patients who underwent neoadjuvant chemotherapy, the median overall survival was 712 days (23.7 months), [95% CI 668–769], and the median progression-free survival – 400 days (13.3 months), [95% CI 347–465]
Summary
There is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer. The aim of this study was to compare the impact of the adjuvant and neoadjuvant chemotherapy regimens on the clinical outcomes in patients with advanced ovarian cancer. Despite new medical and surgical advances and new chemotherapeutic regimens, the overall 5-year survival for patients with stage III and IV epithelial ovarian cancer has remained relatively unchanged over the last 40 years. After the application of cytoreductive surgery and adjuvant chemotherapy with cisplatin/cyclophosphamide, the 5-year survival among stage III cases is 10–20%, and among stage IV cases – even below 10%. Patients with tumours sensitive to chemotherapy can be treated with optimal cytoreductive surgery, and increased overall and progression-free survival can be expected. The feasibility of optimal surgery and the prognosis of patients with chemoresistant tumours are lesser
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