Neoadjuvant Chemotherapy For Ovarian Cancer Research Articles

Comparison of Long-Term Survival Rates of Primary Surgery and Surgery After Neoadjuvant Chemotherapy in Ovarian Cancer

Comparison of Long-Term Survival Rates of Primary Surgery and Surgery After Neoadjuvant Chemotherapy in Ovarian Cancer

Effect of neoadjuvant chemotherapy for ovarian cancer on sedative potency of propofol and oxycodone for anesthesia induction

Objective To evaluate the effect of neoadjuvant chemotherapy for ovarian cancer on the sedative potency of propofol and oxycodone for anesthesia induction. Methods Sixty-eight American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 40-64 yr, with body mass index of 20-30 kg/m2, scheduled for elective radical resection of ovarian cancer with general anesthesia, were divided into into 2 groups(n=34 each)according to whether the patients received neoadjuvant chemotherapy before surgery: neoadjuvant chemotherapy group(groupⅠ)and non-chemotherapy group(group Ⅱ). Patients received 3 cycles of chemotherapy(21 days for 1 cycle), chemotherapy regimen was paclitaxel and carboplatin, and patients underwent surgery after 3 weeks of chemotherapy in group Ⅰ.Anesthesia was induced with Ⅳ oxycodone 0.2 mg/kg.Propofol was given by target-controlled infusion 4 min later, and the effect-site concentration(Ce)of propofol was determined by up-and-down technique, with the initial Ce 1.0 μg/ml and the ratio between the two successive Ces 1.09.The median-effective target plasma concentration(EC50)and 95% confidence interval of propofol causing loss of consciousness were calculated using Probit analysis. Results The EC50 and 95% confidence interval of propofol causing loss of consciousness were 1.22 μg/ml(1.14-1.30 μg/ml)and 1.74 μg/ml(1.57-3.19 μg/ml)in group Ⅰ and group Ⅱ, respectively.Compared with group Ⅱ, the EC50 of propofol causing loss of consciousness was significantly decreased in group Ⅰ(P<0.05). Conclusion Neoadjuvant chemotherapy for ovarian cancer can enhance the sedative potency of propofol and oxycodone for anesthesia induction. Key words: Oxycodone; Chemotherapy, adjuvant; Propofol; Sedation

Neoadjuvant chemotherapy is associated with a high rate of perioperative blood transfusion at the time of interval cytoreductive surgery

BackgroundThe oncologic safety of allogeneic blood transfusion in ovarian cancer patients is unknow. We sought to determine the prevalence and oncologic safety of perioperative allogeneic blood transfusion during interval cytoreduction surgery among women receiving neoadjuvant chemotherapy for ovarian cancer.MethodsWe utilized retrospective chart review to identify a cohort of patients undergoing interval cytoreduction at a large academic tertiary referral center. We compared outcomes in patients who were exposed to perioperative blood transfusion compared with patients who were not exposed. Our primary endpoint was progression free survival; our secondary endpoint was overall survival. Baseline clinical characteristics were collected for patients in each group.ResultsSixty-six women were included in the final cohort of women undergoing interval cytoreductive surgery after NACT. A total of 51 women (77%) were exposed to allogeneic perioperative pRBC transfusion. Fifteen women (23%) were not exposed to transfusion. The baseline characteristics were generally well matched. Women who were not exposed to a perioperative blood transfusion were more likely to have a normalized CA125 prior to undergoing cytoreductive surgery. Preoperative hemoglobin concentration was lower in the transfusion group (10.5 g/dLvs 11.5 g/dL, p < 0.009). Perioperative transfusion was not associated with a significant difference in progression free survival (PFS = 7.6 months for transfused, 9.4 months for not transfused; log-rank test p = 0.4617). Similarly, there was no observed difference between groups for overall survival (OS = 23.6 months for transfused, 22.5 months for not transfused; log-rank test p = 0.1723).ConclusionsWomen undergoing neoadjuvant chemotherapy for ovarian cancer are at high risk of exposure to blood transfusion at the time of interval cytoreductive surgery. Future studies will continue to evaluate the safety and impact of transfusion on ovarian cancer survival in this at risk population.

Neoadjuvant chemotherapy is associated with a high rate of perioperative blood transfusion at the time of interval cytoreductive surgery

The oncologic safety of allogeneic blood transfusion in ovarian cancer patients is unknow. We sought to determine the prevalence and oncologic safety of perioperative allogeneic blood transfusion during interval cytoreduction surgery among women receiving neoadjuvant chemotherapy for ovarian cancer. We utilized retrospective chart review to identify a cohort of patients undergoing interval cytoreduction at a large academic tertiary referral center. We compared outcomes in patients who were exposed to perioperative blood transfusion compared with patients who were not exposed. Our primary endpoint was progression free survival; our secondary endpoint was overall survival. Baseline clinical characteristics were collected for patients in each group. Sixty-six women were included in the final cohort of women undergoing interval cytoreductive surgery after NACT. A total of 51 women (77%) were exposed to allogeneic perioperative pRBC transfusion. Fifteen women (23%) were not exposed to transfusion. The baseline characteristics were generally well matched. Women who were not exposed to a perioperative blood transfusion were more likely to have a normalized CA125 prior to undergoing cytoreductive surgery. Preoperative hemoglobin concentration was lower in the transfusion group (10.5 g/dLvs 11.5 g/dL, p < 0.009). Perioperative transfusion was not associated with a significant difference in progression free survival (PFS = 7.6 months for transfused, 9.4 months for not transfused; log-rank test p = 0.4617). Similarly, there was no observed difference between groups for overall survival (OS = 23.6 months for transfused, 22.5 months for not transfused; log-rank test p = 0.1723). Women undergoing neoadjuvant chemotherapy for ovarian cancer are at high risk of exposure to blood transfusion at the time of interval cytoreductive surgery. Future studies will continue to evaluate the safety and impact of transfusion on ovarian cancer survival in this at risk population.

Minimally invasive interval debulking surgery after neoadjuvant chemotherapy for ovarian cancer

Minimally invasive interval debulking surgery after neoadjuvant chemotherapy for ovarian cancer

Let-7d-3p is associated with apoptosis and response to neoadjuvant chemotherapy in ovarian cancer

Altered expression of microRNAs contributes to the heterogeneous biological behavior of human malignancies and it may correlate with the clinical pathological features of patients. The let-7 microRNA family is frequently downregulated in human cancers and its aberrant expression may be a useful marker for prediction of the clinical response to therapy in patients. In the present study, we analyzed the expression of three members of the let-7 family (let-7a-3p, let-7d-3p and let-7f), which remains largely uncharacterized in ovarian cancer tissues. We also investigated the function of let-7d-3p in the apoptosis and sensitization to chemotherapy in ovarian cancer cells. Our data from stem-loop quantitative RT-PCR showed that expression of let-7a-3p and let-7d-3p, but not let-7f, was significantly (P<0.04) upregulated in ovarian tumors relative to that noted in normal ovarian tissues. Markedly, an increased expression of let‑7d-3p (also known as let-7d-3*) was associated with positive response to carboplatin/paclitaxel treatment in ovarian cancer patients. To investigate the biological relevance of let‑7d-3p, we knocked down its expression in SKOV-3 ovarian cancer cell line using antagomiRs. Loss of function analysis showed that inhibition of let-7d-3p significantly (P<0.05) impaired cell proliferation and activated apoptosis. In contrast, scratch/wound healing and Transwell chamber assays showed that migration and invasion abilities were not affected in the let-7d-3p-deficient SKOV-3 cancer cells. Notably, AnnexinV assays showed a significant (P<0.05) increase in cell death of cancer cells treated with the let-7d-3p inhibitor plus carboplatin indicating a synergistic effect of the drug with antagomiR therapy. Gene ontology classification of predicted targets of let-7d-3p identified a number of genes involved in cellular pathways associated with therapy resistance such as ABC transporters, HIF-1, RAS and ErbB signaling. In summary, our findings showed that inhibition of let-7d-3 activates apoptosis and that its upregulation is associated with a positive response of ovarian cancer patients to carboplatin/paclitaxel chemotherapy.

Incidence and Timing of Thromboembolic Events in Patients With Ovarian Cancer Undergoing Neoadjuvant Chemotherapy.

To identify the incidence and timing of venous thromboembolism as well as any associated risk factors in patients with ovarian, fallopian tube, or primary peritoneal cancer undergoing neoadjuvant chemotherapy. We conducted a retrospective cohort study of patients diagnosed with ovarian, fallopian tube, and primary peritoneal cancer and receiving neoadjuvant chemotherapy from January 2009 to May 2014 at a single academic institution. The timing and number of venous thromboembolic events for the entire cohort were categorized as follows: presenting symptom, during neoadjuvant chemotherapy treatment, after debulking surgery, and during adjuvant chemotherapy. Of the 125 total patients with ovarian cancer undergoing neoadjuvant chemotherapy, 13 of 125 patients (10.4%, 95% confidence interval [CI] 6.1-17.2%) had a venous thromboembolism as a presenting symptom and were excluded from further analysis. Of the 112 total patients at risk, 30 (26.8%, 95% CI 19.3-35.9%) experienced a venous thromboembolism. Based on the phase of care, 13 (11.6%, 95% CI 6.8-19.1%) experienced a venous thromboembolism during neoadjuvant chemotherapy, six (5.4%, 95% CI 2.4-11.5%) developed a postoperative venous thromboembolism, and 11 (9.9%, 95% CI 5.5-17%) developed a venous thromboembolism during adjuvant chemotherapy. Two of the four patients with clear cell histology developed a venous thromboembolism in this cohort. Overall new diagnosis of venous thromboembolism was associated with one fourth of the patients undergoing neoadjuvant chemotherapy for ovarian cancer with nearly half of these diagnosed during chemotherapy cycles before interval debulking surgery. Efforts to reduce venous thromboembolism so far have largely focused on the postoperative period. Additional attention to venous thromboembolic prophylaxis during chemotherapy (neoadjuvant and adjuvant) in this patient population is warranted in an effort to decrease the rates of venous thromboembolism.

Neoadjuvant chemotherapy in ovarian cancer revisited

Despite the recent publication of two randomized controlled phase III trials addressing neoadjuvant chemotherapy in advanced ovarian cancer, the optimal timing of multimodal management in primary therapy is still under debate. As both studies met their primary end point by demonstrating non-inferiority, neoadjuvant chemotherapy followed by interval debulking surgery has been proposed to be an alternative standard for primary ovarian cancer treatment. Nevertheless, significant questions remain unanswered in both trials. Especially, the radicality of surgical therapy was below expectation with the median operating times of <3 h and complete gross resection in <20% of the patients. Consecutively, survival rates of patients undergoing primary debulking surgery were low. Since the primarily surgical question of 'primary versus interval-surgery' can only be answered if the key criteria 'complete gross resection' are present in a considerable percentage of patients, additional studies are needed and neoadjuvant chemotherapy should not be used to reduce surgical radicality for ovarian cancer treatment.

Insulin-Like Growth Factors and Their Binding Proteins in Tumors and Ascites of Ovarian Cancer Patients: Association With Response To Neoadjuvant Chemotherapy

Purpose:Tumor cell growth and sensitivity to chemotherapy depend on many factors, among which insulin-like growth factors (IGFs) may play important roles. The aim of the present study was to evaluate the levels of insulin-like growth factors (IGFs) and IGF binding proteins (IGFBPs) in primary tumors and ascites as predictors of response to neoadjuvant chemotherapy in ovarian cancer (OC) patients.Materials and Methods:Tumor tissue samples and ascitic fluid were obtained from 59 patients with advanced OC. The levels of IGF-I, IGF-II, IGFBP-3, IGFBP-4 and PAPP-A were determined using ELISA kits. Taking into account the data on expression of these IGF-related proteins and outcome, logistic regression was performed to identify predictors of response to neoajuvant chemotherapy.Results:Human ovarian tumors expressed IGFs, IGFBP-3, IGFBP-4 and PAPP-A and these proteins were also present in ascites fluid and associated with its volume. IGFs and IGFBPs in ascites and soluble PAPP-A might play a key role in ovarian cancer progression. However, levels of proteins of the IGF system in tumors were not significant predictors of objective clinical response (oCR). Univariate analysis showed that the level of IGF-I in ascites was the only independent predictor for oCR.Conclusion:The level of IGF-I in ascites was shown to be an independent predictor of objective clinical response to chemotherapy for OC patients treated with neoadjuvant chemotherapy and debulking surgery.

Neoadjuvant chemotherapy for ovarian cancer: do we have enough evidence?

Neoadjuvant chemotherapy for ovarian cancer: do we have enough evidence?

Minimally invasive surgery versus laparotomy for interval cytoreduction after neoadjuvant chemotherapy for ovarian cancer

Minimally invasive surgery versus laparotomy for interval cytoreduction after neoadjuvant chemotherapy for ovarian cancer

Pathologic assessment of response to neoadjuvant chemotherapy in ovarian cancer: Correlation with survival

Pathologic assessment of response to neoadjuvant chemotherapy in ovarian cancer: Correlation with survival

Debulking Surgery and Intraperitoneal Chemotherapy Are Associated With Decreased Morbidity in Women Receiving Neoadjuvant Chemotherapy for Ovarian Cancer

The aims of this study were to compare the rate of completion of optimal debulking and/or 6 cycles of intraperitoneal (IP) chemotherapy in women with International Federation of Gynecologists and Obstetricians stage III/IV ovarian cancer undergoing neoadjuvant chemotherapy (NACT) versus primary surgery (PS) and to compare morbidity between these 2 groups. Ninety-six subjects with stage III/IV ovarian cancer who underwent either NACT or PS were identified. Data comparisons include rate of optimal debulking and completion rate of 6 cycles of IP chemotherapy. Other data collected included surgical times, length of stay, intensive care unit admissions, blood transfusions, bowel resections, major complications, and dose reductions. SigmaStat version 2.0 was used for statistical analysis. Of the 96 subjects, 38 received NACT and 58 had PS. All 14 subjects with stage IV disease received NACT, and all experienced resolution of pleural effusion, based on computed tomographic imaging. Thirty-five (92%) of 38 NACT subjects versus 47 (81%) of 58 PS subjects were optimally debulked (P = 0.08). Thirty-six (95%) of 38 NACT subjects versus 37 (64%) of 58 PS subjects completed IP chemotherapy (P < 0.001). Length of stay was 3.26 (NACT) versus 5.08 (PS) days (P < 0.001). Intensive care unit admissions were 1 of 38 (NACT) versus 12 of 58 (PS) (P < 0.001). Bowel resections were done in 2 of 38 (NACT) versus 14 of 38 (PS) (P < 0.05). Duration of surgery was 96 minutes (NACT) versus 138 minutes (PS) (P < 0.001). A trend to fewer dose reductions occurred in NACT (1/38) versus PS (8/58) (P = 0.056). The NACT subjects were more likely to complete IP chemotherapy and had decreased length of stay, intensive care unit admissions, bowel resections, and duration of surgery. Both optimal debulking and dose reductions were numerically but not statistically associated with NACT versus PS. This likely reflects a relatively high overall rate of optimal debulking and low rate of dose reductions in these subjects and would require a larger group to determine significance.

Clinical Trials of Neoadjuvant Chemotherapy for Ovarian Cancer: What Do We Gain After an EORTC Trial and After Two Additional Ongoing Trials Are Completed?

The aim of neoadjuvant chemotherapy is to reduce the tumor volume or spread of the disease before the main treatment, and it could possibly make the main procedures easier or less invasive. Although the standard therapeutic strategy for advanced ovarian cancer is a maximum primary debulking surgery followed by chemotherapy, a European Organisation for Research and Treatment of Cancer (EORTC) prospective randomized trial demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to the standard procedure. This study raised a number of controversies, particularly regarding the quality of debulking surgery. To solve the questions, we need to wait for the results of two additional ongoing randomized trials. However, the results of those two trials must be carefully assessed, because the quality of debulking surgery would significantly affect survival, and may make the interpretation of the trial results more confusing and difficult.

Emerging Concerns When Evidence-Based Medicine Is Translated into Real Life: The Case of Neoadjuvant Chemotherapy in Ovarian Cancer

Keywords Ovariancancer .Neoadjuvantchemotherapy .Optimalcytoreduction .SurgeryMore than 70 % of patients with epithelial ovarian cancerare diagnosed with an advance stage of disease. For deca-des, the therapeutic approach to these patients has consistedof cytoreductive surgery followed by a platinum-based che-motherapy regimen. Although there are no randomized clin-ical trials confirming that cytoreductive surgery improvessurvival, several retrospective studies as well as one meta-analysis have shown that the most important prognosticfactor for patients with advanced epithelial ovarian canceris the amount of residual disease after surgical cytoreduction[1, 2]. Constantly in the literature, the absence of macro-scopic residual disease after debulking surgery has beenassociated with better overall survival [3–5]. Recently, thefourth Ovarian Cancer Consensus Conference stated that theexpression “optimally debulked patients” should be re-served for those patients without residual macroscopic dis-ease after debulking surgery [6].However, the likelihood of achieving the objective of“optimal cytoreduction” is highly dependent on the skillsand experience of the surgical team operating on the patient.There are several data in the literature showing that that therate of optimal cytoreduction increases when the surgeonwho operates on an ovarian cancer patient is a well-trainedsubspecialist in gynecologic oncology [7, 8]. The mainreason for this is probably the necessity of sometimesperforming very complex procedures during the surgery inorder to obtain the goal of absence of residual disease. Suchprocedures might include, for instance, bowel resections,radical retroperitoneal lymphadenectomies, splenectomies,partial pancreatectomies, or resection of diaphragmaticimplants. Unfortunately, the training of the surgical teamsoperating on ovarian cancer patients around the world is nothomogeneous and, unlike in countries in which there is anofficial accreditation or specialization, we cannot expect thesame results from different teams in different parts of theworld or even in the same country. This heterogeneity canalso stimulate a further debate, beyond the scope of thisarticle, about the validity of performing clinical trials inwhich the main intervention is a complex surgical procedureas well as about the quality control in such as trials.Eisenkop and Spirtos [9], in an illustrative survey amongAmerican gynecologic oncologists, found that the main limi-tation for obtaining complete cytoreduction was the approachtotheupperabdomen,reinforcingtheneedforspecialtrainingfor the optimal surgery in this disease. Additionally, we havedatashowingthatthebetterthetrainingofthesurgicalteamincomplex procedures, including the approach to the upperabdomen, the higher is the rate of optimal cytoreductionamong these patients [10, 11].Neoadjuvant chemotherapy consists in the administrationof some courses of chemotherapy before surgery. This strat-egy has been used when the surgical team has considered itimpossible to achieve adequate cytoreduction in an individ-ual patient. Despite the absence of consensus on the criteriafor considering a patient to not be a candidate for upfrontsurgery, there are some patient circumstances that are uni-versally accepted, for instance, bad clinical condition of the

The role of neoadjuvant chemotherapy in ovarian cancer patients with extensive tumor burden

To the editor: I read with great interest the article by Menczer et al. [1] on the outcome prediction before neoadjuvant chemotherapy (NAC) in ovarian cancer. In the study, the authors indicated that progression free survival (PFS) of ovarian cancer patients who underwent NAC was not different between marked improvement group and no/some improvement group. The median PFS of the two groups were 7.9 and 7.2 months. Of course, as the authors addressed, the small size of this study may not provide enough evidence to draw any meaningful conclusion. However, as a hypothesis-developing study, this study raised several important hypotheses that should be considered in the future studies on the role of NAC in ovarian cancer. First, this study suggested no meaningful correlation between the response to NAC and clinical outcome, i.e., PFS, after interval debulking. The short PFS in this study may not be surprising because they gave NAC to the selected high-risk patients by criteria suggested by Nelson et al. [2], i.e., extensive upper abdominal disease and/or extraperitoneal disease. As the authors did not observe any difference of PFS between good vs. poor responders, this result may be interpreted as a challenge to the role of NAC in patients with extensive tumor burden. Although the authors did not compare the rate of successful cytoreduction between good and poor responders, it is obvious that surgical cytoreduction would be easier in good responders to NAC. This may imply that enhanced feasibility of cytoreduction provided by NAC may have no role in these setting, especially in terms of prognosis. This interesting observation should be confirmed in further studies. In addition, it should be also noted that CA-125 decreased more than 50% in all patients in the study. Thus, it is possible that all patients may be similarly benefited by NAC in terms of surgical resectability. If this is the case, the cytoreduction outcome between good and poor responders may not be dramatically different in this study. Personally, I experienced that more than 50% CA-125 reduction is sufficient to increase feasibility of cytoreduction in patients with extensive tumor burden. Therefore, I would like to indicate that the cutoff dividing 'no/some improvement' and 'marked improvement' group may be arbitrary. If the extent of chemoresponse to NAC was regarded as a continuous variable in this study, this study would have been much more informative.

Interaction between preoperative CA-125 level and survival benefit of neoadjuvant chemotherapy in advanced epithelial ovarian cancer

Objective This study aims to determine whether neoadjuvant chemotherapy (NAC) has survival benefit in selected patients with advanced epithelial ovarian cancer (EOC) who have high risk of suboptimal cytoreduction which is represented by high serum CA-125 level. Methods We retrospectively reviewed records of 314 patients with EOC including 94 patients who received NAC. After stratification by preoperative CA-125 levels, the progression-free survival (PFS) was compared between the NAC group and the primary debulking surgery (PDS) group. Results The NAC group had more FIGO stage IV disease ( P < 0.001) and higher CA-125 levels ( P < 0.001). Although suboptimal resection rate was higher in the PDS group (50% vs. 18%, P < 0.001), however, NAC was not associated with increased PFS in multivariate Cox analysis ( P = 0.334). Nevertheless, after stratification according to CA-125 levels, NAC showed survival benefit in the subgroup with high CA-125 levels (> 2000 U/ml; HR 0.62, P = 0.037). Conclusion Our preliminary data suggests the possible interaction between CA-125 levels and survival benefit of NAC. The randomized trial data about NAC should be stratified by the reproducible and relevant criteria such as preoperative serum CA-125 level to elucidate true survival benefit of NAC in ovarian cancer.

Neoadjuvante Chemotherapie beim Ovarialkarzinom – ein sinnvolles Vorgehen?

Neoadjuvante Therapien werden in der Onkologie eingesetzt, um durch Tumorverkleinerung operationstechnische Vorteile zu erlangen. Darüber hinaus kann die Bewertung des Therapieansprechens hilfreiche Hinweise auf den weiteren Verlauf der Erkrankung liefern. Das epitheliale Ovarialkarzinom erscheint aufgrund seiner frühen und ausgedehnten peritonealen Metastasierung, seiner Chemosensitivität und aufgrund der prognostischen Bedeutung des verbleibenden postoperativen Tumorrests für ein neoadjuvantes Therapiekonzept besonders geeignet. Seit vielen Jahren ist die neoadjuvante Chemotherapie beim Ovarialkarzinom umstritten, ohne dass größere kontrollierte Studien zu diesem Thema durchgeführt wurden. Die Ergebnisse mehrerer Phase-II-Studien, u. a. einer deutschen Multicenter-Phase-II-Studie (PRIMOVAR), und die einer ersten großen Phase-III-Studie (EORTC 55971) liegen jetzt vor: Eine frühe Beurteilbarkeit des Ansprechens, eine geringere perioperative Morbidität und Mortalität bei den neoadjuvant therapierten Patientinnen und nahezu identische Raten an progressionsfreiem Überleben und Gesamtüberleben im Vergleich zur Standardtherapie werden die Diskussion um diese Therapieform neu beleben.

The Optimal Debulking after Neoadjuvant Chemotherapy in Ovarian Cancer: Proposal Based on Interval Look During Upfront Surgery Setting Treatment

The optimal goal of interval debulking surgery (IDS) following neoadjuvant chemotherapy (NAC) remains undefined. The aim of this study was to determine the optimal goal of IDS following NAC on the basis of long-term survival by the disease status at the end of interval look surgery (ILS) or IDS during the treatment in the setting of upfront primary debulking surgery (PDS). From January 1986 through December 2000, we performed treatment in the setting of upfront PDS in 128 patients with Stage III/IV epithelial ovarian cancer. Sixty-six patients with residual disease (RD) at PDS underwent interval surgery (IS) such as ILS or IDS; 4 patients after two cycles of chemotherapy and 62 after three or more cycles. We investigated how disease status at the end of IS was associated with overall survival (OS). The 5-year OS rates for no, minimal and gross RD were not available (n = 0), 67% (n = 3) and 0% (n = 1) after two cycles, and 47% (n = 42), 0% (n = 18) and 0% (n = 2) after three or more cycles, respectively. No visible tumors at the end of IS after three or more cycles of chemotherapy were necessary for 5-year survival. If the optimal goal of IDS is defined as the surgery that is expected to result in long-term survival in the NAC setting treatment, our data on the assessment of peritoneal findings during the upfront PDS setting treatment suggest that only complete resection with no RD could be the optimal goal of IDS in the NAC setting treatment.

A case of bowel perforation after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

Background. Bowel perforation is a rare complication of chemotherapeutic treatment of cancer, and may result from tumor necrosis within involved bowel or as a function of the mechanism of the chemotherapeutic agent itself. Case. We present a case of a 71-year-old woman who experienced a spontaneous bowel perforation after a single cycle of carboplatin and paclitaxel during neoadjuvant treatment of advanced epithelial ovarian cancer. This is, to our knowledge, the first reported case of a gastrointestinal perforation with neoadjuvant chemotherapy for ovarian cancer. The clinical circumstances were highly suggestive of a tumor lysis mechanism for the perforation. Conclusion. Bowel perforation can occur as a direct consequence of cytotoxic neoadjuvant chemotherapy for advanced ovarian cancer. This potential serious complication may be worthy of consideration when deciding between neoadjuvant chemotherapy and primary surgical management.