The Significance of Duration of Chemotherapy Interruptions Due to Interval Surgery in Ovarian Cancer Patients Treated With Neoadjuvant Chemotherapy

Abstract

ObjectiveTo examine the prognostic significance of interruptions to chemotherapy arising from delayed primary surgical debulking following neoadjuvant chemotherapy in women undergoing treatment for ovarian cancer. MethodsWe carried out a retrospective chart review to identify women with ovarian cancer who were treated with neoadjuvant chemotherapy and planned delayed primary surgical debulking. Cox regression modelling was used to identify significant predictors of progression-free and overall survival, using well-established prognostic variables and time delays between courses of chemotherapy perioperatively, stratified by residual disease status. ResultsNinety-seven patients with complete data were identified. Their median age was 65.4 years. Fifty-four patients (56%) were left with optimal residual disease (< 1 cm), and 43 patients had suboptimal residual disease. The median delay from the last cycle of chemotherapy to the time of surgery was 29 days (range 20–72). The median delay from surgery to resumption of cytotoxic therapy was 23 days (range 8–65). Chemotherapy courses were interrupted for a median of 50 days (range 36–119) around the time of surgery. No effect was observed on progression-free interval by interruptions to chemotherapy, regardless of residual disease status. With respect to overall survival, the time to resumption of chemotherapy in days and the time delay in days between the two chemotherapy cycles peri-operatively were identified as statistically significant predictors only in patients with suboptimal residual disease. In patients with optimal residual disease status, neither the time of interruption between the two chemotherapy cycles peri-operatively nor the time to resumption of chemotherapy after surgical debulking was significantly predictive of overall survival. ConclusionIn women undergoing treatment for ovarian cancer, the interval between surgery and the resumption of chemotherapy in patients with suboptimal residual disease should be kept as short as possible.