Delay In Adjuvant Chemotherapy Research Articles

Risk Factors for Suboptimal Colon Cancer Diagnosis and Management at a Safety-Net Hospital System

IntroductionColon cancer (CC) is the second leading cause of cancer-related deaths in the United States. Quality measures have been introduced by the American Gastroenterological Association and Commission on Cancer for optimal management of CC. In this study, we sought to identify factors that may hinder the timely diagnosis and treatment of CC at a safety-net hospital system. MethodsRetrospective chart review was performed for patients aged ≥18 y diagnosed with CC from 2018 to 2021. Primary outcomes were time from positive fecal immunochemical test to colonoscopy, time from diagnosis to surgery, and time from diagnosis to adjuvant chemotherapy. Secondary end points were demographic characteristics associated with suboptimal outcomes in any of the above measures. ResultsOne hundred ninety patients were diagnosed with nonmetastatic CC. The majority were Hispanic and non-English–speaking. 74.1% of patients with a positive fecal immunochemical test received a colonoscopy within 180 d. 59.6% of nonemergent cases received surgery within 60 d of diagnosis. 77% of those eligible received adjuvant chemotherapy within 120 d of diagnosis. No clinically significant demographic factor was associated with delay in colonoscopy, surgery, or adjuvant chemotherapy. Most frequent cause of delay in surgery (38.0%) was optimization of comorbidities. Most frequent cause of delay in adjuvant chemotherapy (71.4%) was delay in surgery itself. ConclusionsNo clinically significant demographic factor was associated with experiencing delays in diagnostic colonoscopy, surgery, or adjuvant chemotherapy.

Predictors of Timely Initiation and Completion of Adjuvant Chemotherapy in Stage II/III Colorectal Adenocarcinoma.

Background: Adjuvant chemotherapy (AC) for colorectal cancer (CRC) has led to substantial improvement in survival. Several clinical trials advocate the initiation of AC within 6-8 weeks of surgical resection based on evidence of improved survival with early initiation of AC. We aim to evaluate factors that predict initiation and completion of AC, subsequently improving survival. Methods: We identified 451 patients who underwent resection for CRC between 2014 and 2022. One hundred ten patients had stage II/III colorectal cancer who underwent resection followed by AC. Multivariable logistic regression analysis was performed to identify factors significantly predicting delay in AC >8 weeks. Secondary outcomes included chemotherapy completion rate, recurrence-free survival, and overall survival. Results: The final analysis included 110 patients. The median time to initiation of adjuvant chemotherapy (TIAC) was 6.9 weeks (IQR: 5.8-9.5). In total, 36.4% of patients had a delay >8 weeks to initiation of AC, and only 40% completed treatment. The surgical approach (open vs laparoscopic vs robotic) had no effect on the TIAC. On multivariable logistic regression analysis, preoperative albumin ≥3.5 (OR = .31; 95% CI: .12-.80) was an independent predictor of timely initiation of AC. Completion of AC was associated with a higher overall survival. Discussion: Preoperative nutritional status predicted delay in initiation of AC. Patients with a delay in AC beyond eight weeks had a lower rate of AC completions and worse survival. It is imperative to optimize this aspect of treatment as it correlates with survival.

Time to initiation of adjuvant chemotherapy and survival in patients with stage II and III rectal cancer not receiving total neoadjuvant therapy

Abstract Objectives While the delay in adjuvant chemotherapy (AC) is known to impact colon cancer outcomes, its effect on rectal cancer is less clear. This study aims to evaluate the influence of AC timing on survival in stage II and III rectal cancer. Methods This retrospective multicenter study enrolled 1,144 patients receiving chemotherapy following resection of stage II–III rectal cancers. The effect of delayed AC on survival was assessed using multivariable Cox models with restricted cubic splines and logistic regression. Results Compared to patients initiating AC within four weeks postsurgery, those initiating within 5–8 weeks had a similar survival (HR=0.85, 95 % CI=0.66–1.11), whereas those initiating within 8–12 weeks (HR=1.62, 95 % CI=1.05–2.51) or beyond 12 weeks (HR=2.07, 95 % CI=1.21–3.56) had a significantly inferior survival. A delayed time to chemotherapy (>8 weeks) was associated with worse survival in patients aged ≥60 years but not in younger patients (<60 years: HR=1.36; 95 % CI=0.75–2.46, p=0.312; ≥60 years: HR=2.37; 95 % CI=1.56–3.60, p<0.001). Additionally, our exploratory analysis suggested that FOLFOX and FOLFIRI were more effective when starting within 5–8 weeks post-surgery, while CAPEOX and a single agent showed a slight advantage when starting within four weeks. Conclusions Our findings advocate for initiating AC within eight weeks post-surgery in stage II–III rectal cancer, especially in older patients. Delayed treatment is linked to significantly worse survival outcomes.

Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications

BackgroundNo residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS).ResultsR0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed.ConclusionsImproved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications.

Adjuvant Chemotherapy Delay After Primary Debulking Surgery for Advanced Ovarian Cancer at a Teaching Hospital in Southern Nigeria

Adjuvant Chemotherapy Delay After Primary Debulking Surgery for Advanced Ovarian Cancer at a Teaching Hospital in Southern Nigeria

The optimal time of starting adjuvant chemotherapy after curative surgery in patients with colorectal cancer

BackgroundPostoperative adjuvant chemotherapy (AC) is now well-accepted as standard for high-risk stage II and stage III colorectal cancer (CRC) patients, however the optimal time to initiate AC remains elusive.MethodsA comprehensive literature search was performed using the PubMed and Embase databases. The Hazard ratio (HR) with the corresponding 95% confidence interval (CI) was used as an effect measure to evaluate primary endpoints. All analyses were conducted using Stata software version 12.0 with the Random-effects model.ResultsA total of 30 studies were included in our study. Upon comparison on overall survival (OS), we identified that delaying the initiation of AC for > 8 weeks after operation was significantly associated with poor OS (HR: 1.37; 95% CI: 1.27—1.48; P < 0.01). The poor prognostic value of AC delay for > 8 weeks was not undermined by subgroup analysis based on region, tumor site, sample size and study quality. No obvious differences were observed in survival between AC within 5–8 weeks and ≤ 4 weeks (HR: 1.03; 95% CI: 0.96 -1.10; P = 0.46). Moreover, two studies both highlighted that the survival benefit of AC was still statistically significant when AC was applied 5–6 months after surgery compared with the non-chemotherapy group.ConclusionsDelaying the initiation of AC for > 8 weeks after surgery was significantly associated with poor OS. AC started within 8 weeks after surgery brought more benefits to CRC patients. There were no obvious differences in survival benefits between AC within 5–8 weeks and ≤ 4 weeks. Compared to patients not receiving AC after surgery, a delay of approximately 5–6 months was still useful to improve prognosis.

Splenectomy in epithelial ovarian cancer surgery

ObjectiveSplenectomy is performed in 4–32% of cytoreductive surgeries for ovarian cancer. The objective of our study was to assess splenectomy and evaluate its impact on overall and disease-free survival.MethodsWe conducted...

Surgical site infection after cytoreductive surgery in patients with ovarian, fallopian tube and primary peritoneal cancer, is an independent predictor of poor overall survival via significant delays in adjuvant chemotherapy

Surgical site infection after cytoreductive surgery in patients with ovarian, fallopian tube and primary peritoneal cancer, is an independent predictor of poor overall survival via significant delays in adjuvant chemotherapy

Association between Serum Biomarkers with Postoperative Complications and Delay of Adjuvant Chemotherapy Initiation in Ovarian Cancer Patients Undergoing Primary Cytoreductive Surgery: A Pilot Study

This study sought to describe and relate the factors associated with complications and delays in adjuvant chemotherapy in patients with ovarian cancer treated with primary cytoreductive surgery. Serum from patients diagnosed with ovarian cancer scheduled for primary cytoreductive surgery were analyzed for prealbumin, 25-OH Vitamin D, intracellular adhesion molecule 1 (ICAM-1), interleukin 6 (IL-6), interleukin 8 (IL-8), monocyte chemoattractant protein 1 (MCP-1), monocyte chemoattractant protein 2 (MCP-2), macrophage derived chemokine (MDC). Postoperative complications were identified using common terminology criteria for adverse events 4.0 and 30 day after surgery. Delays in adjuvant chemotherapy were defined as >1 week interval between surgery and initiation. Patients with postoperative complications (39.6%) were significantly older, had lower serum prealbumin levels, and higher serum IL-6 and IL-8 than those without. Univariate logistic regression found that age (OR: 1.12, 95%CI: 1.00-1.35) and IL-6 (OR: 1.02, 95%CI: 0.99-1.05) were associated with postoperative complications, whereas age remained significant after multivariate analysis (OR:1.14, 95%CI: 1.00-1.29). Patients with delays in chemotherapy exhibited greater BMI and lower 25-OH Vitamin D than those without. Multivariate analysis found that increasing levels of 25-OH Vitamin D were associated with a lower risk of delayed chemotherapy initiation after controlling for age, body mass index, and tumor grade (OR: 0.93, 95%CI:0.87-0.99). This work suggests that in addition to age being predictive of postoperative complications, serum 25-OH Vitamin D may a provide insight into a patient’s risk for postsurgical delays in chemotherapy initiation. These findings should, however, be confirmed in a larger study including robust survival analysis.

420P Predictive factors of post-operative acute kidney injury after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis: A retrospective cohort study

Cytoreductive surgery (CRS) is a major surgery which consist of extensive tumor debulking, peritonectomy, and multiple visceral resections. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique in which chemotherapy is delivered in a heated solution perfused throughout the peritoneal space. In centers performing CRS-HIPEC, a significant survival benefit were observed; However, the rate of post-operative complications remains high. Acute kidney injury is a post-operative complication associated with increased morbidity and mortality and may cause delay in adjuvant chemotherapy or worse, may render the patient ineligible to receive systemic chemotherapy.

Analysis of delay in adjuvant chemotherapy in locally advanced rectal cancer.

Adjuvant chemotherapy (AC) after neoadjuvant chemoradiation and surgical resection has been the standard of care for locally advanced rectal cancer. However, there are no evidence-based guidelines regarding the optimal timing of AC for rectal cancer. The objective of this study was to evaluate the effect of AC timing on overall survival for rectal cancer. The National Cancer Database (NCDB) from 2004 to 2016 was queried for primary clinical stage II or III rectal cancer patients who had undergone neoadjuvant chemoradiation followed by surgery and AC. Patients were grouped based on AC initiation: early ≤ 4weeks, intermediate 4-8weeks, and delayed ≥ 8weeks. The primary outcome was overall survival. We identified 8722 patients, of which 905 (10.4%) received early AC, 4621 (53.0%) intermediate AC, and 3196 (36.6%) delayed AC. Pathological lymph-node metastasis (ypN +) was positive in 73% of early AC, 74% intermediate AC, and 63% delayed AC (p < 0.05). The 5-year survival probability was 71.1% (95% CI 68-74%) for early AC, 73.2% (95% CI 72-75%) intermediate AC, and 65.8% (95% CI 64-68%) delayed AC (p < 0.001). Using Cox proportional hazard modeling, patients undergoing delayed AC had an associated decreased survival compared to patients receiving early AC (HR 1.18; 95% CI 1.028-1.353, p = 0.018) or intermediate AC (HR 1.28; 95% CI 1.179-1.395, p < 0.01). Delay in AC administration may be associated with decreased 5-year survival. Compared to early or intermediate AC, patients in the delayed AC group were observed to have increased risk of death, despite having lower proportions with ypN + disease. Patients with higher socioeconomic and education status were more likely to receive early chemotherapy.

Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction.

BackgroundPatients with breast cancer undergoing mastectomy should be offered the option of immediate breast reconstruction (IBR). The aim of this retrospective study was to assess whether there is a delay in the initiation of adjuvant chemotherapy in patients undergoing mastectomy with or without IBR.MethodThe study included patients aged 70 years or younger with clinically node-negative breast cancer who underwent unilateral mastectomy with IBR (IBR group) or mastectomy alone (no-IBR group) followed by adjuvant chemotherapy at the Helsinki University Hospital between January 2012 to July 2018.ResultsA total of 645 patients were included; 186 in the IBR group and 459 in the no-IBR group. Sixty-six (35.5 per cent) patients in the IBR group and 102 (22.2 per cent) patients in the no-IBR group received their first chemotherapy cycle later than 6 weeks after surgery (P < 0.001). The respective numbers for later than 8 weeks were 17 (9.1 per cent) and 14 (3.1 per cent) (P = 0.001). Among all 645 patients, postoperative complications were a significant risk factor for a delay in the initiation of chemotherapy. Sixty-seven (39.9 per cent) patients with and 101 (21.2 per cent) patients without complications had a delay in chemotherapy (P < 0.001). The delay in chemotherapy was due to complications in 39 (59.1 per cent) in the IBR group and in 28 (27.5 per cent) in the no-IBR group (P < 0.001).ConclusionPatients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within 6 weeks after surgery compared with the IBR patients. IBR significantly increased the risk of postoperative complications in comparison with mastectomy alone. The complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy.

Irregular delay of adjuvant chemotherapy correlated with poor outcome in stage II-III colorectal cancer

AimsAdjuvant chemotherapy (ACT) plays an important role in improving the survival of stage II-III colorectal cancer (CRC) patients after curative surgery. However, the prognostic role of irregular delay of ACT (IDacT) for these patients has been less studied.Materials and methodsA total of 117 stage II-III CRC patients who underwent radical resection and received at least 3 months ACT were enrolled retrospectively. The significance of IDacT, including total delay (TD) and delay per cycle (DpC), in predicting disease-free survival (DFS) was determined using receiver operating characteristic curve (ROC) analysis. The survival differences between the TD, DpC-short and DpC-long subgroups were tested using Kaplan–Meier analysis, and risk factors for prognosis were determined using a Cox proportional hazards model.ResultsUsing 35.50 and 3.27 days as the optimal cut-off points for TD and DpC, respectively, ROC analysis revealed that TD and DpC had sensitivities of 43.60% and 59.00% and specificities of 83.30% and 62.80%, respectively, in predicting DFS (both P < 0.05). No differences in the clinicopathological parameters were found between the TD, DpC-short or -long subgroups except histological differentiation in different TD subgroups and combined T stages in different DpC subgroups (both P = 0.04). Patients in the TD or DpC-long group exhibited significantly worse survival than in the -short group (TD: Log rank = 9.11, P < 0.01; DpC: Log rank = 6.09, P = 0.01). DpC was an independent risk factor for prognosis (HR = 2.54, 95% CI: 1.32–4.88, P = 0.01).ConclusionsIDacT had a profound effect on the outcome for stage II-III CRC. Although TD and DpC were significant for the prognosis, DpC was more robust, and patients who presented DpC for a long time had a significantly worse DFS.

Comment on "Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence".

To the Editor, We read with interest the article by Koedam et al.1 demonstrating anastomotic leakage as an independent risk factor for local recurrence after rectal cancer surgery. We congratulate the authors and agree that COLOR trial2 was not powered to be able to extrapolate data on anastomotic leaks and also how in a pre-FOLFOX era the outcomes of stage III colon cancer remained the same irrespective of chemotherapy. However, with respect to the COLOR II observations,3 we have the following concerns. The authors have noted that an ileostomy was performed in 52.4% (44/84) of patients with an anastomotic leak but we observe that “ileostomy” was not included as a factor in the univariate analysis for local recurrence at 5-years follow-up. In COLOR II, performing a diverting ileostomy was left to the discretion of the operating surgeon without being part of a protocol. As seen in COLOR II, preoperative radiation may lead to the increased rate of anastomotic leaks3,4 and not doing a diverting ileostomy can exaggerate sub-clinical leaks which would have not manifested otherwise.5,6 If anastomotic leaks increase the local recurrence,1,7 then the very purpose of neoadjuvant radiation to improve local control in rectal cancers would be defeated. In today’s era, to facilitate the timely administration of the adjuvant treatment and hence further decrease the recurrence rates, an ileostomy may at times prove beneficial. The authors, in the discussion, propose that increased recurrences after anastomotic leaks may be attributed to a delay in adjuvant chemotherapy (although rightly stated as not applicable to COLOR II). This reasoning may have been applicable if there were an increase in distant recurrences in addition to the local recurrences, which is not the case. The authors have referred to a hypothesis of spillage of cancer cells into the peritoneal cavity during the surgery and adhesion of tumor cells due to the inflammatory response of the leak. If this hypothesis is to be believed then the incidence of distant peritoneal failure should also be seen along with or apart from local recurrences. Anastomotic leaks in this analysis were not seen to cause seeding of distant peritoneal sites. Also, we observe that 5 of 23 patients (25.2%) with positive resection margins had a local recurrence at 5 years and 9 of 84 patients (13.3%) with anastomotic leaks had a local recurrence at 5 years. However, it would be interesting to note how many patients with positive resection margins had anastomotic leaks. We are not sure what could be the likely explanation for the increased recurrences in patients who had anastomotic leaks but this finding gives grounds to further evaluate total neoadjuvant treatment to treat rectal cancers,8 other than evaluating this important observation in a trial powered to study the same.

Impact of the COVID-19 pandemic on cancer incidence and mortality

Impact of the COVID-19 pandemic on cancer incidence and mortality

Direct to implant reconstruction with adjustable permanent Becker implant expanders with ADM following de-epithelised skin reducing mastectomy in high-risk overweight and obese patients with severe ptosis

Overweight and obese patients with severe ptosis undergoing mastectomy and reconstruction present a challenge to the oncoplastic breast surgeon. This paper investigates early-to medium-term outcome of high-risk overweight and obese women with severe ptosis undergoing de-epithelised skin reducing mastectomy and direct to implant reconstruction with Becker implant expanders. From Nov 2016 and April 2021, 20 Wise pattern skin reducing mastectomies (SRM) were performed, 18 with Adjustable Permanent Becker Implant expanders (APBI) and 2 with fixed volume implants. Median age was 48 years (27–73), and median FU was 21 months (4–49). There were 8 smokers and 7 patients needed radiation treatment. In the ABPI group, there was one infection, 3 patients had threatened wounds which needed revision, and one patient lost her implant. There was no locoregional recurrence or distant metastasis. There was 1 week delay in adjuvant chemotherapy for a patient with wound issues following reconstruction. One patient is awaiting autologous reconstruction following deformity subsequent to radiation treatment. In conclusion the use of APBI following de-epithelised skin reduction surgery in this high-risk group is an option with acceptable early-to medium-term outcome.

Primary peritoneal carcinoma and ovarian carcinoma - a ten-year comparative analysis.

Primary peritoneal carcinoma (PPC) at presentation often masquerades as epithelial ovarian carcinoma (OC) but behaves different with respect to treatment response, recurrence patterns and has inferior outcomes. The objective of this study is to compare the clinicopathological features and survival outcomes of PPC and OC. Prospectively maintained database of patients presenting to the gynecologic oncology department at a tertiary hospital was reviewed between 1st January 2010 and 31st December 2020. A comparative analysis of high-grade serous stage III/IV PPC and OC was done. Demographics, treatment details, complications and survival outcomes were collected from electronic medical records. 151 OC and 69 PPC patients were included. A higher proportion of women with PPC had reduced performance status prior to hysterectomy with salpingo-oophorectomy, a shorter symptom to treatment interval, and large volume ascites. A significantly lower number of women with PPC (4.3 vs. 46.1%; P &lt; 0.001) underwent primary cytoreduction, had a lower median surgical complexity score (3 vs. 4; P &lt; 0.001) but higher recurrence rates (66.7 vs. 47.0%; P = 0.041) as compared to the patients with OC. The median progression-free survival (PFS) was 18 (15-20) months in PPC and 23 (17-28) months in OC patients (log-rank P = 0.034), while the median overall survival (OS) was similar (44 vs. 48 months; log-rank P = 0.696). The presence of extraperitoneal disease and interval cytoreduction was associated with shorter PFS. Suboptimal cytoreduction and delay in adjuvant chemotherapy beyond 6 weeks post-surgery was associated with reduced OS. PPC is an aggressive disease with lower PFS compared to OC. Commonly presenting with large volume carcinomatosis, it is not amenable for primary cytoreduction, making the usage of neoadjuvant chemotherapy a common practice and pragmatic approach.

Survival of stage III colon cancer patients with adjuvant chemotherapy: Experience from a specialized cancer institute in Latinoamerica - Peru.

204 Background: In Peru, colon cancer is the 5th most common cause of cancer and the sixth most deadly. Currently, surgery remains as the only curative therapy, however, there is risk of recurrence. Adjuvant chemotherapy has become a useful tool to improve progression-free survival (PFS) and overall survival (OS). In this study, we determine the current survival of our stage III colon cancer patients, submitted to adjuvant chemotherapy, and if this is similar to the evidence seen in large international studies; also, we analyze if delay of adjuvant chemotherapy has impact on survival. Methods: This descriptive cross-sectional study involved 162 patients with stage III colon cancer who underwent a resection surgery and received adjuvant fluoropyrimidine-based chemotherapy. They were evaluated, according to the TNM classification (tumor, nodule), as low risk (T1-T3, N1) and high risk (T4, N2). We also classified patients, according to the weeks of delay from surgery to adjuvant chemotherapy, into subgroups of 6, 8 and 10 weeks. Results: The mean age was 63.7 years, 63 patients were women (38.9%), 99 patients (61.1%) were men. Only 38.3% of patients started adjuvant chemotherapy in the first 6 weeks after surgery, and 85.8% of patients, in the first 10 weeks; the median time from surgery to initiation of adjuvant chemotherapy was 7.0 weeks. We estimated that, at 3 years, the median PFS is 73.5% (95% CI: 65.8-82.1). The 3-year PFS in the low-risk group was 82.9% (95% CI: 72.3-95.0) and 67.3% (95% CI: 57.2-79.2) in the high-risk group. It was estimated that at 3 years, the median OS is 81.1% (95% CI: 75.2-87.5). The 3-year OS in the low-risk group was 87.9% (95% CI: 80.4-96.2) and 76.0% (95% CI: 67.8-85.3) in the high-risk group. Conclusions: The PFS and OS in Peruvian population is similar to data evidenced in international historical studies such as the IDEA trial. This study, also, suggests that starting adjuvant treatment within 10 weeks does not present an impact on OS and PFS in our population.

The Impact of Adjuvant Therapy Delay on Survival Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Background: In this study we leveraged a large administrative database to investigate temporal and comparative effects of adjuvant chemotherapy (AC) and adjuvant chemoradiotherapy (ACRT) following pancreaticoduodenectomy (PD) for pancreas adenocarcinoma (PAC). Methods: NCDB was queried for patients with PAC who underwent PD between 2010-2018. Only patients with complete data were included. Patients who received neoadjuvant, as well as those who never received any adjuvant therapy, were excluded. Cox multivariable regression analyses were performed. Results: 8763 patients met inclusion criteria. Delay of ≥60-days to AC was seen in 39.1% of the patients. While early vs. delayed initiation of AC afforded no survival benefit to the margin-negative cohort (p=0.263), AC <60 vs. ≥60-days suggested a small survival benefit among margin-positive patients (No Delay-AC vs. Delay-AC, 16.6 vs 16.3 months), and when corrected for confounders this effect was significant (p=0.041, HR 0.845, 95%CI 0.704-0.998). In contrast, among margin-positive patients, ACRT with and without delay was associated with statistically identical outcome (No Delay vs. Delay, 19.9 vs 19.4 months, p=0.054), with similar results across margin-positive treatment subgroups after correcting for confounders (No delay-AC vs Delay-ACRT, p=0.74, HR 1.031, 95%CI 0.861-1.234). Conclusion: Delay of AC ≥60-days may be associated with worse survival in patients with positive margins following PD for PAC. This negative effect was not observed among margin-positive patients with a delay of ACRT ≥60-days. These findings suggest that consideration should be given to delivery of ACRT rather than AC in patients with positive margins when delay of adjuvant therapy ≥60-days cannot be avoided.

Association between time to adjuvant chemotherapy and outcomes in low grade ovarian cancer

Low-grade ovarian cancers comprise <10% of all ovarian cancers and are relatively chemo-resistant compared to high-grade subtypes. While studies have shown that a delay in adjuvant chemotherapy for high-grade serous ovarian cancer is associated with worse survival, no such relationship has been studied in low-grade ovarian cancers. The objective of this study is to determine the association between timing of adjuvant therapy initiation and survival outcomes in patients with low-grade ovarian, fallopian tube, and primary peritoneal carcinoma.