Neoadjuvant Chemotherapy with Carboplatin-Paclitaxel Followed by Interval Debulking Surgery Versus Primary Surgery in Advanced Ovarian Cancer
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- Category: Vol. 81, March 2013
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Neoadjuvant Chemotherapy with Carboplatin-Paclitaxel Followed by Interval Debulking Surgery Versus Primary Surgery in Advanced Ovarian Cancer,NIVEEN A. ABO TOUK and DALIA H. ZAYED
Abstract
Purpose: This study aims to evaluate the response to neoadjuvant chemotherapy (NAC) in patients with advanced epithelial ovarian cancer (EOC) and compare survival rates and morbidity in patients who received NAC followed by interval debulking surgery then adjuvant chemotherapy to those who underwent primary debulking surgery followed by adjuvant chemotherapy.
Patients and Methods: Sixty eight patients with stage III or IV EOC were randomized to either receive three cycles of neoadjuvant chemotherapy (carboplatin-paclitaxel) (33 pa-tients) followed by interval debulking surgery in all patients with responsive disease followed by at least three cycles of the same chemotherapy regimen or underwent primary de-bulking surgery followed by at least six cycles of adjuvant carboplatin-paclitaxel (35 patients).
Results: Complete response (CR) was obtained after NAC in 5 patients (15.2%) and partial response was reached in 21 patients (63.6%), at surgery pathological complete response was confirmed in 2 patients. Optimal debulking was reached in 75% of patients in the NAC group versus 51.4% in the other group (p0.056). After a median follow-up of 26 months (2-63 months), on comparing NAC group to primary debulking surgery group, median overall survival was 30 versus 25 months (p=0.643) and progression free survival (PFS) was 20 and 16 months respectively (p=0.552). Perioperative complications were more in the primary debulking surgery group with a statistical significance in the incidence of blood transfusion as well as the rate of bladder and bowel resection.
Conclusion: Stage III and IV EOC treated with NAC followed by interval debulking surgery have a similar prognosis compared to primary debulking surgery. NAC was associated with a strong trend for less operative morbidity and higher rate of optimal debulking, suggest that NAC and interval surgery is an important consideration for women with advanced epithelial ovarian carcinoma.