Abstract
Background: Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer. Methods: This study was performed on eligible patients with ovarian cancer admitted in Surgical Oncology and Medical Oncology departments at South Egypt Cancer Institute-Assiut University in the period from January 2010 to December 2015. Patients were divided into two groups, the first group included those who have NACT and underwent IDS plus adjuvant chemotherapy, and the second group included those who underwent PDS followed by adjuvant chemotherapy. Results: This study included 380 cases. One hundred and fifty-four patients (40.53%) had IDS. The remaining two hundred and twenty-six patients (59.47%) underwent PDS. In this study, treatment modality was significant for both disease-free survival (DFS) and overall survival (OS). DFS was significantly reduced after IDS when compared to PDS (median DFS: 33.00 months vs. 45.00 months, respectively; p 0.001). Also, OS was significantly reduced after IDS when compared to PDS. (Median OS: 43 months vs. 46 months, respectively; p = 0.047). Moreover, this drop of the survivals mainly occurred in specific subgroups such as the elderly patients, patients with bad performance status, suboptimal cytoreduction, as well as high-grade tumors. Conclusion: This study showed that PDS resulted in a better disease-free survival and overall survival than IDS. Moreover, OS and DFS have significantly dropped in specific patients’ subgroups. Therefore, patients selection should be considered.
Highlights
Ovarian cancer (OC) is the fifth most common cause of cancer-related death among women [1]
Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer
This study showed that PDS resulted in a better disease-free survival and overall survival than IDS
Summary
Ovarian cancer (OC) is the fifth most common cause of cancer-related death among women [1]. Several retrospective studies concluded that there was no difference in disease-free survival (DFS) or overall survival (OS) for patients with advanced ovarian cancer treated with IDS in comparison to PDS [7] [8] [9] [10] [11]. A more recent meta-analysis of multiple central randomized trials concluded that survival was similar in patients treated with NACT followed by interval debulking surgery compared to primary debulking followed by chemotherapy, and they even criticized Bristow and Chi meta-analysis [13] [14]. The aim of this retrospective study is to evaluate the outcome of IDS after primary NACT compared to PDS followed by adjuvant chemotherapy for FIGO stage III epithelial ovarian cancer
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