Interval from neoadjuvant chemotherapy to interval debulking surgery in advanced ovarian cancer: Is this a prognostic indicator?

Abstract

5084 Background: We hypothesized that longer interval between neoadjuvant chemotherapy and interval debulking surgery (IDS) may have an adverse effect on survival. We analyzed the data of patients with advanced epithelial ovarian cancer to evaluate the effect of interval from last cycle of chemotherapy to interval debulking surgery (IDS) on progression free and overall survival. Methods: We retrospectively analyzed case records of 86 patients of advanced epithelial ovarian cancer (stage IIIC and IV) who received neoadjuvant chemotherapy and underwent IDS at our centre from Jan 2001 to Dec 2008. Data was obtained for age, stage of the disease, operative procedure, pathology, recurrence and survival. Response rate was compared using 2 sided chi square test. Progression free (PFS) and overall survival (OS) were analyzed using Kaplan Meier technique with log rank test. Hazard ratio was obtained by cox regression model. Results: Patients' median age was 50 years (range 32 to 75). 55 patients had stage IIIC and stage IV-31. A median of 3 chemotherapy cycles were administered prior to IDS (range, 3-7) and the median interval between last cycle of chemotherapy and IDS was 41 days (range 16-93 days). 67.5% patients had optimal debulking (residual disease ≤ 1 cm). 44 patients were operated within 42 days and 42 patients underwent surgery after 42 days. The response rate (complete + partial) was higher for patients operated within 42 days (40/44 vs. 30/42, p < 0.02). At a median follow up of 30 months- the median overall and PFS for whole group is 37 months (95% CI: 30-44) and 13 months (95% CI: 11-15), respectively. Both PFS and OS rates are significantly higher for patients operated within 42 days of last chemotherapy cycle; PFS: 18 vs. 9 months, p < 0.0001, HR-2.86 (95% CI:1.76-4.67) and OS: 45 vs. 27 months, p < 0.003, HR-2.19 (95% CI:1.27-3.79). Conclusions: This study indicates adverse outcome for patients who undergo interval debulking surgery more than 6 weeks after last cycle of neoadjuvant chemotherapy. No significant financial relationships to disclose.