Abstract
ObjectiveWe aimed to performed a meta-analysis and systematic review on the role of neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in advanced ovarian cancer (AOC) patients.Materials and MethodsWe searched PubMed, EMBASE, and the Cochrane Library for relevant articles. All statistical analyses were performed in Review Manager 5.3.5.ResultsIn two randomized controlled trials (RCTs), there was no significant difference in overall survival (OS) (HR = 0.93, 95% CI: 0.81–1.06) or progression-free survival (PFS) (HR = 0.97, 95% CI: 0.86–1.09). Few adverse events (HR = 0.37, 95% CI: 0.19–0.72) and a high optimal debulking surgery rate (HR = 1.69, 95% CI: 1.50–1.91) were observed with NACT. In 22 observational studies, primary debulking surgery (PDS) yielded better OS (HR = 1.38, 95% CI: 1.19–1.60) but not progression-free survival (PFS) (HR = 1.03, 95% CI: 0.86–1.23). An increased optimal cytoreduction rate (HR = 1.17, 95% CI: 1.12–1.22) was observed with NACT. Irrespective of the degree of residual disease, OS was longer in the PDS group than that in the NACT group. Patients with FIGO stage III (HR = 1.43, 95% CI: 1.05–1.95) and IV (HR = 1.14, 95% CI: 1.06–1.23) disease had better survival with PDS.ConclusionsTreatment with NACT-IDS improves perioperative outcomes and optimal cytoreduction rates, but it may not improve OS. NACT-IDS is not inferior to PDS-CT in terms of survival outcomes in selected AOC patients. Future studies should focus on candidate selection for NACT.
Highlights
Epithelial ovarian cancer is currently the most malignant gynecological carcinoma worldwide
In two randomized controlled trials (RCTs), there was no significant difference in overall survival (OS) (HR = 0.93, 95% confidence intervals (CIs): 0.81–1.06) or progressionfree survival (PFS) (HR = 0.97, 95% CI: 0.86–1.09)
In 22 observational studies, primary debulking surgery (PDS) yielded better OS (HR = 1.38, 95% CI: 1.19–1.60) but not progression-free survival (PFS) (HR = 1.03, 95% CI: 0.86–1.23)
Summary
Epithelial ovarian cancer is currently the most malignant gynecological carcinoma worldwide. The management of ovarian cancer has changed during the past few decades because not all patients are candidates for PDS followed by chemotherapy (PDS-CT), due to either extensive tumor burden or poor performance [5]. In this situation, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative treatment option for patients who are initially unlikely to undergo optimal debulking surgery, www.impactjournals.com/oncotarget patients with FIGO stage IIIC or IV disease. The second definition is currently widely acknowledged by gynecologic oncologists and considers NACT as the primary treatment, viewing the following surgery as interval cytoreduction [11]. It should be emphasized that only the second definition of NACT-IDS will be discussed in our article
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