Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: An Institutional Experience

Abstract

Epithelial ovarian cancer is the second most common gynaecological malignancy among Indian women. Primary debulking surgery remains the standard of care in advanced operable ovarian cancer patients, but is associated with morbidity. Neoadjuvant chemotherapy followed by delayed primary cytoreductive surgery may be a better treatment strategy in advanced ovarian cancer. We present our experience of neoadjuvant chemotherapy in advanced ovarian cancer with special emphasis on treatment outcomes. A retrospective analysis of advanced epithelial ovarian carcinoma (stages III and IV) patients treated at the Department of Surgical Oncology at King George’s Medical University, Lucknow, between 2012 and 2016 was done. A total of 128 patients with advanced ovarian carcinoma were treated during this period. Median age at diagnosis was 46 years. Among these patients, 115 underwent surgery, of which 57.4% were optimally cytoreduced. Papillary serous adenocarcinoma was the most common histological subtype (78.1%). Recurrence was seen in 73% of patients, with a median time to recurrence 16 months (range 6.5–37 months). They were managed with second-line chemotherapy and surgery. Median overall survival in this study for optimally cytoreduced stage III patients was 38 months and 17 months for optimally cytoreduced stage IV patients. Median progression-free survival for stage III was 13 months and stage IV was 6 months. Neoadjuvant chemotherapy facilitates surgery in advanced ovarian cancer and helps in assessing chemotherapy responsiveness. It provides an opportunity to modify systemic treatment if there is no response to therapy or disease progression.