Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer
Keywords:
Ovarian neoplasms, neoadjuvant therapy, observational studiesAbstract
Objective: To describe the experience at the National Cancer Institute (NCI) on the use of neoadjuvant chemotherapy as primary treatment for epithelial ovarian cancer among patients in stages IIIC and IV.
Methods: We conducted a descriptive retrospective study (case series type) of patients diagnosed with epithelial ovarian cancer in stages IIIC and IV, treated at the NCI from January 1, 2003 to December 31, 2006, who underwent neoadjuvant chemotherapy as primary treatment. Demographic characteristics and clinical outcomes are described.
Results: Seventeen patients who fulfilled the abovementioned criteria were selected. Once neoadjuvant chemotherapy ended, 5 patients (29.4%) achieved complete or partial clinical response; 4 (23.8%) remained in stable condition, and 8 (47.6%) showed signs of progressive illness. Interval debulking surgery was performed on objective response patients. Maximum cytoreduction was achieved in 5 patients (100%); first relapse was reported at month 18 of follow-up; 2 disease-free survivors were identified in December, 2007; 8 (49%) reported some degree of non-severe chemotherapy-related toxicity. No mortality was related to chemotherapy, no postsurgical complications were observed and no patient required advanced support management.
Conclusions: Neoadjuvant chemotherapy, followed by optimal interval debulking surgery among selected patients, can be an alternative treatment for advanced epithelial ovarian cancer among women with irresecability or the critically ill. Further studies with improved design are required to confirm these findings.
Author Biographies
Juan Avendaño, Instituto Nacional de Cancerología
Grupo de Ginecología Oncológica. Instituto Nacional de Cancerología. Bogotá, Colombia.
Giancarlo Buitrago, Instituto Nacional de Cancerología
Grupo de Investigaciones Clínicas. Instituto Nacional de Cancerología. Bogotá, Colombia.
Pedro Ramos, Instituto Nacional de Cancerología
Grupo de Oncología Clínica. Instituto Nacional de Cancerología. Bogotá, Colombia.
Óscar Suescún, Instituto Nacional de Cancerología
Grupo de Ginecología Oncológica. Instituto Nacional de Cancerología. Bogotá, Colombia.
References
Bristow RE, Chi DS. Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis. Gynecol Oncol. 2006;103(3):1070-6.
https://doi.org/10.1016/j.ygyno.2006.06.025
Dowdy SC, Mullany SA, Brandt KR, Huppert BJ, Cliby WA. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer. 2004;101(2):346-52.
https://doi.org/10.1002/cncr.20376
Hegazy MA, Hegazi RA, Elshafei MA, Setit AE, Elshamy MR, Eltatoongy M, et al. Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma. World J Surg Oncol. 2005;3:57.
https://doi.org/10.1186/1477-7819-3-57
Mazzeo F, Berliere M, Kerger J, Squiff let J, Duck L, D'Hondt V, et al. Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer. Gynecol Oncol. 2003;90(1):163-9.
https://doi.org/10.1016/S0090-8258(03)00249-X
Morrison J, Swanton A, Collins S, Kehoe S. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev. 2007;(4):CD005343.
https://doi.org/10.1002/14651858.CD005343.pub2
Lee SJ, Kim BG, Lee JW, Park CS, Lee JH, Bae DS. Preliminary results of neoadjuvant chemotherapy with paclitaxel and cisplatin in patients with advanced epithelial ovarian cancer who are inadequate for optimum primary surgery. J Obstet Gynaecol Res. 2006; 32(1):99-106.
https://doi.org/10.1111/j.1447-0756.2006.00359.x
Martinez-Said H, Rincon DG, Montes de Oca MM, Ruiz GC, Ponce JL, Lopez-Graniel CM. Predictive factors for irresectability in advanced ovarian cancer. Int J Gynecol Cancer. 2004;14(3):423-30.
https://doi.org/10.1111/j.1048-891x.2004.014301.x
Nelson BE, Rosenfield AT, Schwartz PE. Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol. 1993;11(1):166-72.
https://doi.org/10.1200/JCO.1993.11.1.166
Cliby W, Dowdy S, Feitoza SS, Gostout BS, Podratz KC. Diaphragm resection for ovarian cancer: technique and shortterm complications. Gynecol Oncol. 2004;94(3):655-60.
https://doi.org/10.1016/j.ygyno.2004.04.032
Schwartz PE, Rutherford TJ, Chambers JT, Kohorn EI, Thiel RP. Neoadjuvant chemotherapy for advanced ovarian cancer: long-term survival. Gynecol Oncol. 1999;72(1):93-9.
https://doi.org/10.1006/gyno.1998.5236
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20(5):1248-59.
https://doi.org/10.1200/JCO.20.5.1248
Eisenkop SM, Spirtos NM, Friedman RL, Lin WC, Pisani AL, Perticucci S. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 2003;90(2):390-6.
https://doi.org/10.1016/S0090-8258(03)00278-6
Earle CC, Schrag D, Neville BA, Yabroff KR, Topor M, Fahey A, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst. 2006;98(3):172-80.
https://doi.org/10.1093/jnci/djj019
Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO, et al. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol. 2006;107(1):77-85.
https://doi.org/10.1097/01.AOG.0000192407.04428.bb
Ansquer Y, Leblanc E, Clough K, Morice P, Dauplat J, Mathevet P, et al. Neoadjuvant chemotherapy for unresectable ovarian carcinoma: a French multicenter study. Cancer. 2001;91(12):2329-34.
https://doi.org/10.1002/1097-0142(20010615)91:12<2329::AID-CNCR1265>3.0.CO;2-U
Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Poynor EA, Aghajanian C, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol. 2006;103(3):1083-90.
https://doi.org/10.1016/j.ygyno.2006.06.028
Schwartz PE, Chambers JT, Makuch R. Neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol. 1994;53(1):33-7.
https://doi.org/10.1006/gyno.1994.1083
Magtibay PM, Adams PB, Silverman MB, Cha SS, Podratz KC. Splenectomy as part of cytoreductive surgery in ovarian cancer. Gynecol Oncol. 2006;102(2):369-74.
https://doi.org/10.1016/j.ygyno.2006.03.028
Manci N, Bellati F, Muzii L, Calcagno M, Alon SA, Pernice M, et al. Splenectomy during secondary cytoreduction for ovarian cancer disease recurrence: surgical and survival data. Ann Surg Oncol. 2006;13(12):1717-23.
https://doi.org/10.1245/s10434-006-9048-2
Morice P, Dubernard G, Rey A, Atallah D, Pautier P, Pomel C, et al. Results of interval debulking surgery compared with primary debulking surgery in advanced stage ovarian cancer. J Am Coll Surg. 2003;197(6):955-63.
https://doi.org/10.1016/j.jamcollsurg.2003.06.004
Aletti GD, Gostout BS, Podratz KC, Cliby WA. Ovarian cancer surgical resectability: relative impact of disease, patient status, and surgeon. Gynecol Oncol. 2006;100(1):33-7.
https://doi.org/10.1016/j.ygyno.2005.07.123
Inciura A, Simavicius A, Juozaityte E, Kurtinaitis J, Nadisauskiene R, Svedas E, et al. Comparison of adjuvant and neoadjuvant chemotherapy in the management of advanced ovarian cancer: a retrospective study of 574 patients. BMC Cancer. 2006;6:153.
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