Abstract
ObjectiveTo evaluate the treatment and survival pattern of patients with advanced epithelial ovarian cancer.Methods and resultsRetrospective study of all advanced epithelial ovarian cancer patients treated in the department of gynaecologic oncology from an academic centre, in a four year period from 1 January 2008–31 December 2011.Selection criteriaAll patients with advanced epithelial ovarian cancer (stage III and IV) who underwent surgery from 2008–2011and had a follow-up of at least three months after completion of treatment were included. The decision on whether primary surgery or neoadjuvant chemotherapy (NACT) in advanced ovarian cancer was based on age, performance status, clinical and imaging findings.ResultsA total of 178 cases of epithelial ovarian cancer were operated on during this four year period. Among them 28 patients were recurrent cases, 22 had early stages of ovarian cancer, and the rest 128 had stage III and IV ovarian cancer. In these 128 patients, 50(39.1%) underwent primary surgery and 78(60.9%) had NACT followed by surgery. In the primary surgery group 36(72.0%) patients had optimal debulking while in the NACT group 59(75.6%) patient had optimal debulking. With a median follow-up of 34 months, the median overall survival (OS) and progression free survival (PFS) was 53 and 49 months respectively. Patients who underwent primary surgery had better median PFS than patients who had NACT (56 months versus 39 months, p = 0.002). In stage III C the difference median PFS was significant for those treated with primary surgery when compared with NACT (55 months versus 39 months, p = 0.012). In patients who had optimal debulking to no residual disease (n = 90), primary surgery gave a significant improved PFS (59 months versus 38 months, p = 0.001) when compared with NACT. In univariate analysis, NACT was associated with increased risk of death (HR: 0.350; CI: 0.177–0.693).ConclusionIn advanced epithelial ovarian cancer, primary surgery seems to have a definite survival advantage over NACT in patients who can be optimally debulked to no residual disease.
Highlights
Ovarian cancer is the most deadly of all gynaecological cancers
In stage III C the difference median progression free survival (PFS) was significant for those treated with primary surgery when compared with neoadjuvant chemotherapy (NACT) (55 months versus 39 months, p = 0.012)
NACT was associated with increased risk of death (HR: 0.350; confidence interval (CI): 0.177–0.693)
Summary
Even though new treatments and newer chemotherapeutic agents have been introduced, the five year survival is low, especially in India [1,2,3,4]. It ranks second position in the most common gynaecological cancer among Indian women [5]. The current standard of treatment for epithelial ovarian cancer (EOC) is complete cytoreductive surgery (CRS) to remove the primary tumour and debulking of any metastatic disease combined with systemic chemotherapy using paclitaxel and platinumbased agents (carboplatin/cisplatin), though two recent randomised trials have shown that initial chemotherapy followed by interval debulking surgery is not inferior [6, 7]. In patients who cannot be optimally debulked, NACT (neoadjuvant chemotherapy) followed by interval debulking is the treatment of choice
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