Optimal Cytoreduction Rates Research Articles

Primary cytoreductive surgery followed by chemotherapy compared to neoadjuvant chemotherapy followed by cytoreduction as a treatment for stage III and IV ovarian cancer (literature review)

Standard treatment for advanced ovarian cancer (OC) consists of a combination of chemotherapy and cytoreductive surgery, but practice varies depending on the order of these 2 procedures: neoadjuvant chemotherapy followed by interval debulking surgery or primary cytoreduction followed by adjuvant chemotherapy. The aim of the work is to evaluate methods of treatment of OC of stages III, IV according to FIGO.The literature review includes publications in English from the PubMed, CochraneLibrary and Google Scholar databases on the use of neoadjuvant therapy and primary cytoreduction in late stages of OC (FIGO III–IV). 6 randomized controlled trials, 8 meta-analyses, 8 systematic reviews, 1 case report were identified. Data from publications were distributed according to the criteria for assessing the effectiveness of the treatment: overall and relapse-free survival, perioperative complications, quality of life of patients and the grade of cytoreduction.Neoadjuvant chemotherapy + interval debulking surgery is not inferior to primary debulking surgery + adjuvant chemotherapy in terms of survival outcomes in selected patients, but treatment with neoadjuvant chemotherapy + interval debulking surgery improves perioperative outcomes and optimal cytoreduction rates. It is needed to focus on finding optimal criteria for selecting patients in both groups in future studies of this issue. It is necessary to take into account X-ray, histological studies, the molecular subtype of the tumor, the patient’s condition, the qualifications of the surgical team, the drugs included in chemotherapy.

Primary cytoreductive surgery compared with neoadjuvant chemotherapy in patients with BRCA mutated advanced high grade serous ovarian cancer: 10 year survival analysis

ObjectivesGiven the high response to platinum based chemotherapy in BRCA 1/2 mutated high grade serous ovarian cancers, there is uncertainty about the relative benefits of primary cytoreductive surgery versus neoadjuvant...

Are preoperative serum cancer antigen 125 levels a prognostic factor for outcome in epithelial ovarian cancer? A systematic review.

Most patients with epithelial ovarian cancers (EOC) present with advanced-stage disease because of non-specific symptoms and lack of reliable strategies for early diagnosis. Cancer antigen 125 (CA-125) is suggested as a useful prognostic biomarker, its serum level is raised in over 80.0% of patients with EOC. Primary debulking surgery (PDS) followed by chemotherapy is the conventional treatment, but neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) is offered to patients with unresectable disease. There are inconsistencies regarding the role of preoperative CA-125 serum levels to adopt in stratifying patients for treatment choice that offers the most benefit. This review aimed to determine the role of preoperative CA-125 levels in predicting optimal cytoreduction and the association between optimal cytoreduction and survival outcome in patients with EOC. Three electronic databases CINAHL, Cochrane library and PubMed were searched for potentially relevant articles from 2016 to 2021 on the role of preoperative CA-125 levels in predicting optimal cytoreduction and survival in patients with epithelial ovarian carcinomas. In patients who underwent NACT-IDS, a lower preoperative CA-125 value is a predictor of optimal cytoreduction and an increase in preoperative CA-125 value is consistently associated with a decrease in optimal cytoreduction. There was insufficient data to assess overall survival. However, a raised preoperative CA-125 level is poor predictor of chance of achieving optimal cytoreduction and the rate of optimal cytoreduction was a weak predictor of overall survival in women who had primary debulking surgery.

"Things Have Changed"-Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients.

To report the feasibility of laparoscopic cytoreduction surgery for primary and recurrent ovarian cancer in a select group of patients. A retrospective analysis was conducted on a cohort of patients with FIGO stage IIIA-IV advanced ovarian cancer who underwent laparoscopic primary debulking surgery (PDS), interval debulking surgery (IDS), or secondary debulking surgery (SDS) between June 2008 and January 2020. The primary endpoint was achieving optimal cytoreduction, defined as residual tumor less than 1 cm. Secondary endpoints included evaluating surgical complications and long-term survival, assessed at three-month intervals during the initial two years and then every six months. This study included a total of 108 patients, among whom, 40 underwent PDS, 44 underwent IDS, and 24 underwent SDS. Optimal cytoreduction rates were found to be 95.0%, 97.7%, and 95.8% for the PDS, ISD, and SDS groups, respectively. Early postoperative complications (<30 days from surgery) occurred in 19.2% of cases, with 7.4% of these cases requiring reintervention. One patient died following postoperative respiratory failure. Late postoperative complications (<30 days from surgery) occurred in 9.3% of cases, and they required surgical reintervention only in one case. After laparoscopic optimal cytoreduction with a median follow-up time of 25 months, the overall recurrence rates were 45.7%, 38.5%, and 39.3% for PDS, ISD, and SDS, respectively. The three-year overall survival rates were 84%, 66%, and 63%, respectively, while the three-year disease-free survival rates were 48%, 51%, and 71%, respectively. Laparoscopic cytoreduction surgery is feasible for advanced ovarian cancer in carefully selected patients, resulting in high rates of optimal cytoreduction, satisfactory peri-operative morbidity, and encouraging survival outcomes. Future studies should focus on establishing standardized selection criteria and conducting well-designed investigations to further refine patient selection and evaluate long-term outcomes.

Role of Neoadjuvant Chemotherapy on Advanced Epithelial Ovarian Cancer

&#x0D; &#x0D; &#x0D; &#x0D; Correspondence&#x0D; Dr Manju Pandey , Gynecology Oncology Unit, Dept. of Surgical Oncology, BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Email: drmanju921@gmail.com&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Introduction: Ovarian cancer is the most lethal gynecological malignancy diagnosed at late stage in most of the cases. Management includes primary debulking surgery with a target of no gross residual disease or ≤ 1cm residual disease followed by paclitaxel and carboplatin-based chemotherapy. Neoadjuvant chemotherapy of at least 3 cycles followed by interval debulking surgery is an alternative option in selected cases of advanced disease. Material and Method: A prospective study was carried out at B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan from the period 1st November 2022 to 31st August 2023 (10 months). Patients diagnosed with advanced ovarian cancer based on clinical and CECT findings and confirmed with cytology or FNAC or biopsy undergoing Interval Debulking Surgery after 3 cycles of NACT (paclitaxel and carboplatin) were included. The role of NACT in terms of response according to RECIST criteria, regression of CA125 value, rate of complete or optimal cytoreduction, and postoperative complications were analyzed. Results: A total of 40 cases fulfilling the inclusion criteria were enrolled. Most patients 14(35%) were between 51-60 years with a mean age of 51.45 ± 11.46 SD years. Abdominal pain and/or distension were the most common presenting symptoms. The majority 32 (84.2%) of cases were given NACT based on CT scan findings of advanced disease. Confirmation of malignancy was done by positive USG-guided FNAC from ovarian mass in most cases 23 (57.5%), followed by positive ascitic fluid cytology in 8 (20%) patients. The median CA125 value before and after NACT were 844 U/ml and 27.89 U/ml respectively. After NACT, CA125 was normalized in 24 (60%) patients. Most patients 30 (75%) had complete cytoreduction during IDS; while 7 (17.5%) patients had optimal cytoreduction, and 3 (7.5%) had suboptimal cytoreduction. The median duration of surgery was 147.5 minutes, and the median blood loss was 287.5 ml. The postoperative period was uneventful in most cases. Conclusions: NACT followed by interval debulking surgery is an effective alternative in selected cases of advanced ovarian cancer as the complete and optimal cytoreduction rate is higher with fewer postoperative complications.

Incorporating laparoscopic interval cytoreductive surgery for advanced ovarian cancer-lessons learnt

ObjectiveTo assess the utility of laparoscopy for interval cytoreductive surgery (CRS) in patients with advanced ovarian cancer after Neo-Adjuvant Chemotherapy (NACT). MethodsA retrospective cohort study of interval CRS by laparoscopy in patients with advanced epithelial ovarian cancer treated at a single tertiary gynaecological cancer centre between October 2017 and September 2020. Results86 patients had interval CRS by the laparoscopic route during the study period. The optimal cytoreduction rate (R ​< ​1 ​cm) was 92%, and complete cytoreduction rate with no residual disease (R ​= ​0) was 35%. The intra-operative complication rate was 8% and the estimated blood loss (EBL) was 90 ​ml. The post-operative complication rate was 15%, mostly grade I-II, and the median length of hospital stay was 3 days. ConclusionFor most patients with advanced ovarian cancer after NACT, laparoscopic interval CRS is feasible and effective in achieving optimal cytoreduction while providing a favourable peri-operative outcome. In some cases, however, recourse to laparotomy will optimise complete macroscopic resection.

The effect of older age on treatment outcomes in women with advanced ovarian cancer receiving chemotherapy: An NRG-Oncology/Gynecologic Oncology Group (GOG-0182-ICON5) ancillary study

ObjectiveTo assess the effect of age on overall survival (OS) in women with ovarian cancer receiving chemotherapy. Secondary objectives were to describe the effect of age on treatment compliance, toxicities, progression free survival (PFS), time from surgery to chemotherapy, and rates of optimal cytoreduction. MethodsWomen enrolled in GOG 0182-ICON5 with stage III or IV epithelial ovarian cancer (EOC) who underwent surgery and chemotherapy between 2001 and 2004 were included. Patients were divided into ages <70 and ≥ 70 years. Baseline characteristics, treatment compliance, toxicities, and clinical outcomes were compared. ResultsWe included a total of 3686 patients, with 620 patients (16.8%) ≥ 70 years. OS was 37.2 months in older compared to 45.0 months in younger patients (HR 1.21, 95% CI, 1.09–1.34, p < 0.001). Older patients had an increased risk of cancer-specific-death (HR 1.16, 95% CI, 1.04–1.29) as well as non-cancer related deaths (HR 2.78, 95% CI, 2.00–3.87). Median PFS was 15.1 months in older compared to 16.0 months in younger patients (HR 1.10, 95% CI, 1.00–1.20, p = 0.056). In the carboplatin/paclitaxel arm, older patients were just as likely to complete therapy and more likely to develop grade ≥ 2 peripheral neuropathy (35.7 vs 19.7%, p < 0.001). Risk of other toxicities remained equal between groups. ConclusionsIn women with advanced EOC receiving chemotherapy, age ≥ 70 was associated with shorter OS and cancer specific survival. Older patients receiving carboplatin and paclitaxel reported higher rates of grade ≥ 2 neuropathy but were not more likely to suffer from other chemotherapy related toxicities.Clintrials.gov: NCT00011986

Correlation between PSOGI pathological classification and survival outcomes of patients with pseudomyxoma peritonei treated using cytoreductive surgery and HIPEC: national referral centre experience and literature review.

The Peritoneal Surface Oncology Group International (PSOGI) consensus subdivided pseudomyxoma peritonei (PMP) into four groups according to histopathological features. The aim of this paper is to report survival outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) from a national referral centre and to correlate the PSOGI classification with survival. A retrospective study of a prospectively maintained database was performed. Consecutive patients treated with CRS+HIPEC for PMP of appendiceal origin were included (September-2013 to December-2021). Pathological features of the peritoneal disease were used to classify patients into the four groups proposed by PSOGI. Survival analysis was performed to evaluate the correlation of pathology on overall survival (OS) and disease-free survival (DFS). Overall, 104 patients were identified; 29.6 % were reclassified as acellular mucin (AM), 43.9 % as low-grade mucinous carcinoma peritonei (LGMCP), 22.4 % as high-grade MCP (HGMCP) and 4.1 % as HGMCP with signet ring cells (HGMCP-SRC). Median PCI and rate of optimal cytoreduction were 19 and 82.7 %, respectively. Median OS and DFS were not reached, 5-year OS and DFS were 88.6(SD 0.04) % and 61.6(SD 0.06) %, respectively. Log-Rank test revealed significant differences in terms of OS and DFS across the different histological subgroups (p<0.001 in both cases). However, histology did not retain its significance in the multivariate analysis for OS or DFS (p=0.932 and p=0.872, respectively). Survival outcomes after CRS+HIPEC for PMP are excellent. The PSOGI pathological classification correlates with OS and DFS, but differences were not significant at multivariate analysis when adjusted for other prognostic factors.

Clinical significance of enlarged cardiophrenic lymph nodes by CT in advanced ovarian cancer.

This study aims to assess the clinical influence of enlarged cardiophrenic lymph nodes (CPLN) on staging computed tomography (CT) among patients with advanced ovarian cancer. This retrospective cohort study included 320 patients with advanced epithelial ovarian cancer who underwent staging CT from May 2008 to January 2019. The CPLN diameter was the average of two radiologists' measurements. Enlarged CPLN was defined as a short-axis diameter of ≥5 mm. Clinical and imaging findings, management decisions, and progression-free survival(PFS) were compared between patients with and without enlarged CPLN. Enlarged CPLN was found in 129 (40.3%) patients, which was significantly associated with more pelvic peritoneal carcinomatosis (odds ratio [OR]: 6.61 with 95% confidence interval [CI]: 1.51-28.99), and involved the greater omentum (OR: 6.41, 95% CI: 3.05-13.46), spleen capsule nodules (OR: 2.83, 95% CI: 1.58-5.06), and liver capsule nodules (OR: 2.55, 95% CI: 1.57-4.17). The optimal cytoreduction rates did not differ between patients with and without enlarged CPLN (p = 0.656). The presence of enlarged CPLN had a significant negative influence on PFS (median PFS, 23.5 vs. 80.6 months, respectively, CPLN ≥5 mm versus <5mm; p = 0.023) in patients with no RD after primary debulking surgery, but no adverse effect on PFS among patients with RD (median PFS, 28.0 vs. 24.4 months, respectively, CPLN ≥5 mm versus <5mm; p = 0.359). However, enlarged CPLN on staging CT did not affect PFS in patients treated with neoadjuvant chemotherapy, with (median PFS, 22.4 vs. 23.6 months, respectively, CPLN ≥5 mm versus <5mm; p = 0.360) or without RD (median PFS, 17.7 vs. 23.3 months, respectively, CPLN ≥5 mm versus <5mm; p = 0.400). The enlarged CPLN showed a decreased trend in 81.6% (n = 80) of the patients with enlarged CPLN. No significant difference was found in PFS (p = 0.562) between patients with decreased and increased in the size of CPLN. Enlarged CPLN on staging CT is associated with more abdominal disease but is not reliable in predicting complete resection. Enlarged CPLN awareness is necessary for patients with a primary chance of complete resection of abdominal disease.

Neoadjuvant Chemotherapy Versus Primary Debulking Surgery in FIGO Stage III and IV Epithelial Ovarian, Tubal or Peritoneal Cancer: A Systematic Review and Meta-Analysis.

Objective: To investigate whether neoadjuvant chemotherapy (NACT) confers superior outcomes compared to primary debulking surgery (PDS) in patients with stage III and IV epithelial ovarian, tubal or peritoneal cancer as well as in patients with high tumour load. Methods: We searched the electronic databases PubMed, Cochrane Central Register of Controlled trials, and Scopus from inception to March 2021. We considered randomised controlled trials (RCTs) comparing NACT with PDS for women with epithelial ovarian cancer (EOC) stages III and IV. The primary outcomes were overall survival and progression-free survival. Secondary outcomes were optimal cytoreduction rates, peri-operative adverse events, and quality of life. Results: Six RCTs with a total of 1901 participants were included. Meta-analysis demonstrated similar overall survival (HR = 0.96, 95% CI [0.86-1.07]) and progression-free survival (HR = 0.98, 95% CI [0.89-1.08]) between NACT and PDS. Subgroup analyses did not demonstrate higher survival for stage IV patients (HR = 0.88, 95% CI [0.71-1.09]) nor for patients with metastatic lesions >5cm (HR = 0.86, 95% CI [0.69-1.08]) treated with NACT, albeit with some uncertainty due to imprecision. Similarly, no survival benefit was observed in the subgroup of patients with metastatic lesions >10cm (HR = 0.94, 95% CI [0.78-1.12]). NACT was associated with significantly higher rates of complete cytoreduction (RR = 2.34, 95% CI [1.48-3.71]). Severe peri-operative adverse events were less frequent in the NACT arm (RR = 0.34, 95% CI [0.16-0.72]. Conclusion: Patients with stage III and IV epithelial ovarian cancer undergoing NACT or PDS have similar overall survival. NACT is likely associated with higher rates of complete cytoreduction and lower risk of severe adverse events and peri-operative death.

Sarcoma regimens for gynecologic carcinosarcoma: Is there a benefit? (186)

<b>Objectives:</b> To compare differences in overall survival (OS) in patients with carcinosarcomas of endometrial or ovarian origin who were ever treated with sarcoma chemotherapy regimens compared to those who only received traditional carcinoma regimens. <b>Methods:</b> We conducted a single-institution, retrospective cohort study of patients with a confirmed histologic diagnosis of uterine or ovarian carcinosarcoma diagnosed since the year 2000. Clinical, pathology, and outcomes data were collected. Patients were considered to have received a sarcoma-based regimen if any of their treatment courses included ifosfamide, combination gemcitabine/ docetaxel, or any other regimens listed on the NCCN guidelines for soft tissue sarcomas. Clinical and demographic characteristics were compared across groups using Chi-square, Fisher's exact, or Wilcoxon rank-sum tests. OS was evaluated using a log-rank test. <b>Results:</b> A total of 88 patients with carcinosarcoma of endometrial (77%) or ovarian (22%) origin were identified, 78 of whom had chemotherapy information available. Sixteen (23%) of the patients received chemotherapy that included a sarcoma regimen, 51 (65%) received only carcinoma regimens, and 13 (16%) did not receive any chemotherapy. We excluded ten patients for whom there was no chemotherapy information from the analysis. Among those who received any chemotherapy, there were no significant differences in age, BMI, race, use of radiation, number of lines of chemotherapy received, disease stage, or optimal cytoreduction rate between the two regimen groups. Patients were more likely to have an endometrial primary if they ever received a sarcoma regimen (Table 1). There was no difference in OS between the sarcoma regimen and non-sarcoma regimen groups (HR: 0.71, 95% CI: 0.30-1.64). Older age, stage IV disease, and suboptimal debulking status were associated with shorter OS in this group of patients (p<0.05). <b>Conclusions:</b> Patients who ever received a sarcoma-based regimen did not have longer OS. Since sarcoma regimens tend to have more toxicity, exclusive use of carcinoma regimens for patients with gynecologic carcinosarcomas may be beneficial.

Patterns of treatment and survival outcomes with use of neoadjuvant chemotherapy in ovarian cancer (481)

Patterns of treatment and survival outcomes with use of neoadjuvant chemotherapy in ovarian cancer (481)

Association of BRCA1/2 mutations with prognosis and surgical cytoreduction outcomes in ovarian cancer patients: An updated meta‐analysis

This meta-analysis was conducted to evaluate the impact of BRCA mutations on survival outcomes of ovarian cancer patients and assess whether the BRCA status was an independent predictor of complete cytoreduction. We searched the PubMed, Cochrane, EMBASE, Scopus, Web of Science, and Google Scholar databases for studies that evaluated the associations among BRCA mutations, ovarian cancer survival and surgical cytoreduction before August 2021 based on specific inclusion and exclusion criteria. We identified 61 articles that compared the clinical features, survival outcomes, and optimal surgical cytoreduction rates between BRCA-positive patients and BRCA-negative patients. The results showed that BRCA mutation carriers were diagnosed with ovarian cancer at a younger age than the age at which nonmutation carriers were diagnosed. In addition, BRCA mutation carriers were more likely to be in the International Federation of Gynecology and Obstetrics (FIGO) stage III-IV, and the pathological grade was commonly grade 3. The pathological type of BRCA mutation carriers was more likely to be high-grade serous carcinoma. Patients with BRCA mutations had higher response rates to platinum-based chemotherapy than the noncarriers. However, patients in both groups had equivalent rates of surgical cytoreduction, and BRCA-positive patients had longer overall survival (OS) time (HR=0.65; 95% confidence interval [CI]: 0.59, 0.73; p < 0.001) and longer progression-free survival (PFS) (HR=0.72; 95% CI: 0.63, 0.82; p < 0.001). BRCA mutations appear to be associated with improved OS and PFS in patients with ovarian cancer. However, we did not find any difference in the surgical resection rate between participants in the two groups.

Validation of the integrated prediction model algorithm for outcome of cytoreduction in advanced ovarian cancer.

5546 Background: In advanced ovarian cancer, the decision for primary cytoreductive surgery(PCS) or neoadjuvant chemotherapy(NACT) remains a challenge and may impact survival. We previously developed the integrated prediction model(IPM) using a 4-step algorithm of unresectable stage IVb, patient factors, surgical resectability and surgical complexity to predict outcome of optimal cytoreduction in advanced epithelial ovarian cancer(AEOC) and triage patients to NACT or PCS. The objective of the current study was to validate this model on a retrospective historical cohort of patients. Methods: This is a retrospective cohort study of 107 patients with AEOC treated at the Princess Margaret Cancer Centre between January 2017 and September 2018 undergoing PCS or NACT. All diagnostic imaging was retrospectively reviewed to assign surgical resectability score (SRS) for sites of disease and the surgical complexity score (SCS) for procedures anticipated to be required to achieve optimal cytoreduction based on pre-operative imaging. Those scores were modified from previously validated tools. Patient factors (PF) included age, ECOG and albumin. We previously developed an IPM algorithm to achieve outcome of optimal cytoreduction and determined cut-offs using the Youden index J. Triaging patients to PCS without stage IVb unresectable disease, PF≤ 2, SRS≤5 and SCS≤ 9 led to an 85% specificity and 75% accuracy for outcome of optimal cytoreduction &lt; 1 cm. The current validation study was performed reporting sensitivity, specificity, negative (NPV) and positive predictive value (PPV) on an external cohort. Results: Among 107 patients, 61 had PCS and 46 had NACT followed by ICS. Patients treated with NACT were significantly older (63.5 vs 61 years, p = 0.037), more likely stage IV (52% vs 18%, p &lt; 0.001), had a higher proportion of ECOG &gt; 1 (30% vs 11%, 0.045), a lower pre-operative album (37 vs 40, p &lt; 0.001) and higher CA-125 (970 vs 227.5, p &lt; 0.001) compared to PCS. They also had higher PF (2 vs 0, p = 0.013), SRS (4 vs 1, p &lt; 0.001) and SCS (8 vs 5, p = &lt; 0.001). There was no significant difference in outcome of cytoreduction; the optimal cytoreduction rate was 85% vs 87%, p = 0.12 between PCS and ICS patients. In this validation cohort, triaging patients without unresectable stage IVb disease, PF≤ 2, SRS≤ 5 and SCS≤ 9 to PCS had a sensitivity of 91% to correctly identify patients who will have optimal cytoreduction of &lt; 1 cm at PCS and a specificity of 81%. The PPV was 83%, NPV was 90% and accuracy was 86%. Application of the IPM would have prevented 5 suboptimal patients and correctly triaged them to NACT. Conclusions: We validated a triage algorithm integrating patient factors, surgical complexity and surgical resectability for patients with AEOC to achieve optimal cytoreduction at PCS with high sensitivity and specificity. This may therefore be used in a clinical setting to decide between PCS and NACT.

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is associated with improved perioperative outcomes: a single-center early experience propensity-matched analysis.

The role of laparoscopy in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is not well established. Herein, we describe our early experience of laparoscopic CRS/HIPEC in patients with low-volume peritoneal disease compared to patients who underwent open CRS/HIPEC during the same time period. Using a prospectively maintained database, patients who underwent laparoscopic CRS/HIPEC were compared to a control cohort of patients who underwent open CRS/HIPEC, matched for peritoneal carcinomatosis index (PCI), completeness of cytoreduction, and tumor histology. Between 2008 and 2017, 16 patients underwent laparoscopic CRS/HIPEC and were compared to a matched control cohort of 32 patients who underwent open CRS/HIPEC. Clinical and demographic data were similar between the groups. PCI, number of resected organs, and optimal cytoreduction rates were comparable. Patients who underwent laparoscopic experienced a lower estimated blood loss, (median, [IQR 1-3]); 150mL, [50-300] vs. 100mL, [50-125], p = 0.04, shorter length of stay (median [IQR 1-3]; 4days [3-6] vs. 6days [5-8], p < 0.01, and a lower 30-day complication rate (6.3% vs. 56.3%, p < 0.01). There was no difference in progression-free survival (p = 0.577) and overall survival (p = 0.472) between the groups. This preliminary study demonstrates that laparoscopic CRS/HIPEC is feasible and safe for curative treatment in selected patients with low tumor volume. Minimally invasive CRS/HIPEC is associated with fewer postoperative complications and shorter length of stay. There was no difference in long-term oncological outcomes between the groups.

Feasibility and safety of minimally invasive technology for interval cytoreductive surgery during advanced ovarian cancer after neoadjuvant chemotherapy

Ovarian cancer (OV) is usually diagnosed in its advanced stages (stages III or IV), minimally invasive surgery (MIS) is increasingly being used to treat advanced OV due to several advantages over laparotomy. MIS represents a novel but controversial treatment approach for interval debulking surgery (IDS). The objective of this review was to clarify the feasibility and safety of MIS for IDS. WanFang database, Chinese National Knowledge Infrastructure (CNKI) databases, Embase, PubMed, Cochrane, Clinicaltrials.gov and Web of Science were searched up to June 2022, Clinical studies based on humans, including randomized controlled trials, quasi-RCTs, non-randomized trials, case-control studies, cohort studies and retrospective observational studies, were included without time restriction. 14 original articles published between 2015 and 2022 were included. In total, there were 13,788 patients enrolled, 2318 (16.8%) were treated with MIS. The pooled rate of laparotomy-conversion was 17.9%(112/711), the pooled rate of optimal cytoreduction was 84.0% (628/748) during MIS group compared with 77.3% (2204/2850) during laparotomy (LAP) group (p &lt; 0.0001), and the pooled rate of perioperative complication was 8.85% (79/893) during MIS versus 4.6% (211/4586) during LAP group (p &lt; 0.0001). We found no significant difference in mean progression-free survival (PFS) and mean overall survival (OS) between two groups. Based on the available retrospective studies, minimally invasive debulking surgery after NACT seemed to have similar perioperative, oncological and prognostic outcomes with laparotomy debulking surgery. MIS seemed to be feasible and safe in carefully selected patients who had good response to NACT, lower preoperative levels of CA12-5 and lower tumor burden. However, existed clinical evidence should be viewed with caution and objectivity. MIS for IDS should be cautiously suggested until the observed results are confirmed in the LANCE trial and other larger prospective trials.

Neoadjuvant chemotherapy for advanced stage endometrial cancer: A systematic review

ObjectiveWhile primary cytoreductive surgery (PCS) is considered the standard of care for women who present with stage IV endometrial cancer, neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (ICS) has emerged as an alternative treatment strategy. We summarized the literature and compared outcomes of PCS compared to NACT and ICS. MethodsWe conducted a systematic search on PubMed, Embase, Web of Science, and Scopus for articles published from January 1, 1990 to December 31, 2020. Key search terms included multiple descriptors of advanced disease status in combination with “endometrial cancer” and “neoadjuvant chemotherapy”. Our review included studies that examined survival and surgical outcomes of patients with stage III or IV endometrial cancer treated with neoadjuvant chemotherapy followed by interval cytoreductive surgery versus those who received primary cytoreductive surgery. We excluded studies examining only patients with leiomyosarcomas, carcinosarcomas, and stromal sarcomas due to the biologic heterogeneity of these malignancies. ResultsThe nine included studies encompassed 5,844 patients, of which 1,317 (22.5%) received NACT and 4,527 received PCS (77.5%). With the exception of a single study, all were retrospective observational studies or case series. Use of NACT in patients with stage IV EC increased from 16.0% in 2010 to 23.9% in 2015. Five studies analyzed median overall survival and all but one reported no significant difference between NACT + ICS vs. PCS. Optimal cytoreduction (<1 cm of residual disease) rates were similar across both treatment groups in three separate analyses, however pooled data suggest improved rates of optimal cytoreduction for NACT + ICS vs. PCS patients (81.9% vs. 51.5% respectively). Patients receiving NACT experienced significantly shorter hospital admissions and lower operative times compared to PCS counterparts. ConclusionsNACT followed by ICS reduces perioperative morbidity while offering similar overall survival.

Obesity is associated with poor clinical outcomes in BRCA mutation carriers with epithelial ovarian cancer

<h3>Objectives:</h3> Mutations in <i>BRCA1</i> and <i>BRCA2</i> increase the risk of epithelial ovarian cancer (EOC). Emerging evidence suggests obesity may influence <i>BRCA</i> tumor biology; body mass index (BMI) appears to correlate with DNA damage in breast epithelium in <i>BRCA</i> women. We hypothesized that obesity negatively influences tumor biology in <i>BRCA</i> women with EOC, and sought to identify correlations with BMI and clinical outcomes in this population. <h3>Methods:</h3> We performed an IRB approved retrospective study. We identified patients with <i>BRCA</i>-associated EOC diagnosed between 1990-2015. All women underwent surgical resection with platinum-based chemotherapy. We abstracted clinical and pathologic data, and calculated BMI at the time of diagnosis. Obesity was examined per WHO criteria of normal weight, overweight, class I obesity, and class II obesity. We performed descriptive statistics with Kaplan-Meier, Cox Proportional Hazards Regression, and univariate analyses. <h3>Results:</h3> We identified 179 women meeting criteria. Most were <i>BRCA1</i> (125, or 70%); 53 (30%) were <i>BRCA2</i>; and 1 had both a <i>BRCA1</i> and <i>BRCA2</i> mutation. The majority had stage III/IV disease (137, 77%) and grade 3 serous histology (168, 94%); 150 patients underwent optimal cytoreduction (87%). BMI was distributed throughout the WHO strata: 101 women had normal weight; 46 were overweight; 20 had class I obesity; 12 had class II obesity. Age, medical comorbidities, and rates of optimal surgical cytoreduction were similar among these groups. In a subcohort of patients with stage III/IV disease, we identified a significant trend between increased BMI strata and poor disease-free survival (35, 32, 25, and 13.5 months, <i>p</i>=0.003). This was also observed for overall disease-specific survival (132, 144, 112, and 72.5 months, <i>p</i>=0.0306). Multivariable analyses of the entire cohort confirmed that age (<i>p</i>=0.035), stage (<i>p</i><0.001), and BMI (<i>p</i>=0.017) remained significant independent prognosticators after controlling for grade and optimal cytoreduction. <h3>Conclusions:</h3> We identified a significant and independent association between BMI and clinical outcome in <i>BRCA</i> positive women with EOC. Factors associated with obesity may negatively influence <i>BRCA</i> associated ovarian cancer biology, and suggest this may be a modifiable risk factor to target for therapy.

The correlation between BRCA status and surgical cytoreduction in high-grade serous ovarian carcinoma

<h3>Objectives:</h3> BRCA-associated ovarian cancers are biologically unique, as evident by differential molecular and clinical behaviour of these tumor as compared to sporadic ovarian cancers. It is unclear if these biological differences translate to favorable outcomes at the time of primary cytoreduction. The aim of this study is to compare the amount of residual disease after primary cytoreduction in <i>BRCA</i> mutated and wildtype populations, and to assess whether <i>BRCA</i> status is an independent predictor of optimal cytoreduction. <h3>Methods:</h3> We conducted a retrospective analysis of patients with high-grade serous (HGSC) ovarian cancers with known germline and somatic <i>BRCA</i> mutation status, treated with primary cytoreductive surgery from 2000 to 2017. Post-operative <i>BRCA</i> germline and somatic testing was conducted in all cases. We compared the complete, optimal and suboptimal cytoreduction rates between the <i>BRCA</i> positive and the <i>BRCA</i> negative cohorts and built a predictive model to assess whether the <i>BRCA</i> status was associated with the amount of residual disease after controlling for confounding variables. <h3>Results:</h3> Of 355 women with HGSC ovarian cancers treated with primary cytoreduction, 144 harbored germline or somatic <i>BRCA</i> mutations (41%) and 211 were <i>BRCA</i> wildtype (59%). <i>BRCA</i> positive women tended to be younger (54 vs 59; p<0.001), but there were no differences between the two groups in preoperative CA-125 levels, disease burden (measured by disease score), surgical complexity score, stage distributions, length of surgery, intraoperative or postoperative complications. Comparing residual disease burden at the end of primary cytoreduction, the <i>BRCA</i> positive group had a higher rate of complete cytoreduction to no residual disease (0mm) [75% vs 54%], and a lower rate of optimal cytoreduction (1-9mm) [16% vs 34%] or suboptimal cytoreduction (≥10mm) [9% vs. 12%] (p<0.001). In our predictive model, after accounting for length of surgery, CA-125 level, stage distributions, disease scores and surgical complexity scores, <i>BRCA</i> positive status was predictive of complete cytoreduction to 0mm residual disease with odds ratio (OR) of 4.78 (95% CI 2.32-9.85; p<0.001). Subgroup analysis restricted to patients with stage III/IV HGSC showed similar results, with <i>BRCA</i> positive status having OR of 5.2 (95% CI 2.44-11.09; p<0.001) for complete primary cytoreduction. <h3>Conclusions:</h3> <i>BRCA</i> status is predictive of complete and optimal cytoreduction at the time of primary surgical cytoreduction in patients presenting with newly diagnosed ovarian cancer. This positive correlation should be taken into consideration when deciding between primary cytoreductive surgery or neoadjuvant chemotherapy in women with this disease.

Comparing the Effectiveness of the Treatment with Neoadjuvant Chemotherapy Followed By Interval Debulking and Primary Debulking Followed By Adjuvant Chemotherapy in Advanced Stage Malignant Ovarian Tumors: A Rural Based Study

Background: Advanced epithelial ovarian cancer is also a poorly prognosed condition with elevated death rate The management of advanced ovarian carcinoma is surgical debulking which is followed by adjuvant chemotherapy. Prognosis reflects primarily on the level of cytoreduction obtained in primary surgery. In order to enhance survival, attempts are therefore being made to increase the optimal rates of surgical cytoreduction. NACT has emerged as an important treatment modality. The reasoning behind the NACT protocol is to make advanced untreatable disease operable, increase resection rates of optimal cyto reduction (R0) and promote organ preservation. The application of neo adjuvant chemotherapy will structurally reduce the load of the tumour because of the chemo sensitive nature of the ovarian tissue and enable a greater optimal cytoreduction rate for surgery and an increase in overall survival.&#x0D; Methods: This observational and retrospective study was conducted from 2018-2020, including 71 patients who visited the oncology clinic of OBGY department at AVBRH. Only those who have already diagnosed as stage III and IV ovarian neoplasms and who received primary debulking surgery followed by adjuvant chemotherapy along with neo adjuvant chemotherapy followed by interval de-bulking surgery were included to study the better treatment outcome in terms of intra-operative and post-operative complications and over all and survival without progression in these patients with a follow-up of 2 years.&#x0D; Results: The statistical difference in ooverall survival and progression free survival between primary debulking and NAC / IDS groups was &gt;0.005.But intra operative findings like blood loss, residual disease. Bowel bladder injury, surgery time &amp; post-operative morbidity were less in NAC/IDS group with P value &lt;0.005.&#x0D; Conclusion: In patients having cytoreducible disease which is non optimal or low performance status, NAC / IDS is also a reasonably secure and may be an alternative method for achieving optimal cytoreduction. Investigations aimed at appropriately selecting patients to be treated with NAC and to search for the proper opportunity to conduct IDS can have much better benefits for patients having advanced EOC. It should be underscored that the study is limited to patients with stage 3c or 4 disease.