Neoadjuvant chemotherapy equalizes the optimal cytoreduction rate to primary surgery without improving survival in advan
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GYNECOLOGIC ONCOLOGY
Neoadjuvant chemotherapy equalizes the optimal cytoreduction rate to primary surgery without improving survival in advanced ovarian cancer Salih Tas¸ kın • Mete Gu¨ngo¨r ¨ ztuna Fırat Ortac¸ • Derya O
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Received: 25 December 2012 / Accepted: 10 June 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose(s) To evaluate results of neoadjuvant chemotherapy (NACT) following debulking surgery in patients with extensive metastatic disease and/or poor medical performance Method(s) Advanced stage epithelial ovarian cancer patients were treated with either NACT followed by debulking surgery or primary surgery followed by adjuvant chemotherapy after assessment of the extent of disease by laparoscopy or laparotomy. Results Out of 297, 223 patients were in the primary surgery group, whereas 74 of them met NACT criteria. Optimal cytoreduction rates were 63.2 % in primary surgery group and 60.8 % in NACT group, respectively (p: 0.709). In the primary surgery group, the overall survival was significantly higher (p: 0.002). Mean patient age was more advanced (p: 0.014) and the performance status of patients was poorer (p \ 0.001) in NACT group. Only patient group (primary surgery or neoadjuvant
S. Tas¸ kın F. Ortac¸ Department of Obstetrics and Gynecology, Medical School of Ankara University, Ankara, Turkey S. Tas¸ kın (&) Kadın Hastalıkları ve Dog˘um Anabilim Dalı, Ankara ¨ niversitesi Tıp Faku¨ltesi, Cebeci, 06100 Ankara, Turkey U e-mail: [email protected] M. Gu¨ngo¨r Department of Obstetrics and Gynecology, Medical School of Acıbadem University, Istanbul, Turkey ¨ ztuna D. O Department of Biostatistics, Medical School of Ankara University, Ankara, Turkey
chemotherapy) (p: 0.001) retained significance as predictors of survival in multivariate analyses. Conclusion(s) Improved rate of optimal cytoreduction with NACT in advanced ovarian cancer patients does not prolong survival. The extent of disease at diagnosis is the primary determinant of survival. Randomizing patients with equally extensive disease and performance status to either NACT or primary debulking surgery in a future study will better clarify benefits attributed to NACT. Keywords Neoadjuvant chemotherapy Ovarian cancer Optimal cytoreduction Survival
Introduction Epithelial ovarian cancer is one of the common cancers in women world-wide. A woman’s risk of developing ovarian cancer by age 75 years varies in different countries, ranging from 0.5 to 1.6 % [1]. Great majority of epithelial ovarian cancers are detected at advanced stages and it is the most deadly of all gynecologic malignancies. Standard treatment of ovarian cancer is surgical cytoreduction followed by intravenous platinum-based chemotherapy. Several studies have shown that optimal surgical cytoreduction is one of the most important prognostic factors for survival. Over the past decade, definition of ‘‘optimal cytoreduction’’ has changed from \1 cm to no visible residual disease [2]. A recent Cochrane analysis has shown that women with no residual disease have
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