Abstract
Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and significant increase progression-free survival and overall survival. Both responses to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian cancer.
Highlights
The fifth most common cancer among women is ovarian cancer, and approximately, half of the ovarian cancer patients die from the disease instituting it as the fourth most common cause of gynecologic cancer-related death in most industrialized countries [1] [2]
The purpose of this study is to compare survival in the patient with advanced ovarian cancer underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS)
The results of a large phase III trial reported that women with stages IIIC and IV EOC randomized to Neoadjuvant chemotherapy (NACT) followed by debulking surgery (NACT-IDS) had the same survival as women undergoing PDS followed by chemotherapy (PDS-CTR) [14]
Summary
The fifth most common cancer among women is ovarian cancer, and approximately, half of the ovarian cancer patients die from the disease instituting it as the fourth most common cause of gynecologic cancer-related death in most industrialized countries [1] [2]. Advances in diagnosis and management of epithelial ovarian cancer have changed in the last 25 years, the overall survival has not been improved as approximately 65% to 70% of all ovarian cancer continues to be diagnosed with advanced stage (III or IV). The results of a large phase III trial reported that women with stages IIIC and IV EOC randomized to NACT followed by debulking surgery (NACT-IDS) had the same survival as women undergoing PDS followed by chemotherapy (PDS-CTR) [14]. The purpose is to compare survival in the patient with advanced ovarian cancer (III/IV) underwent primary debulking surgery (PDS-CTR) followed by chemotherapy to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS)
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