Title: Primary Cytoreductive surgery (PS) and Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (NACT/IDS) in Advanced Epithelial Ovarian Cancer (EOC): Regional Cancer Centre Experience
Authors: Dr Shobha Krishnappa, Dr Umadevi. K, Dr Jayashree Natarajan, Dr Rajshekar. S Kunderagi, Dr Pallavi. V. R, Sri. Vijay C. R, Dr P. Sridhar, Dr U. D Bafna
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.19
Abstract
Background: The standard treatment of advanced ovarian cancer [FIGO stage 3 and 4] has been complete cytoreductive surgery (CRS) followed by Platinum based chemotherapy. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (NACT/IDS) has been considered as an alternative to conventional PS in treating advanced EOC.
Objective: Analysis of survival and prognostic factors in advanced EOC patients who underwent Primary Cytoreductive surgery (PS) with Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (NACT/IDS)
Methods: A retrospective analysis of 25 patients who had advanced EOC surgery (stage 3 & 4) between the years 2005-2009. Clinicopathological, potential prognostic factors and progression-free survival (PFS) were analyzed.
Results: No significant difference was seen in the operative time, blood loss among PS and NACT-IDS group. Need for extensive surgeries which included bowel surgeries, diaphragm stripping/ resection, splenectomy, groin node debulking, pelvic/parietal peritonectomy was higher in PS group (53%) when compared to NACT-IDS group (35%).
In optimal cytoreductive group, when patients took complete chemotherapy, the median PFS was 21 months and in patients with incomplete chemotherapy it was 10 months(P=0.025).
In suboptimal cytoreductive group, when complete chemotherapy was taken ,the median PFS was 24 months when compared to 6 months in those who took incomplete chemotherapy(p=0.001). There was no difference in overall survival.
Conclusion: Though in many institutes, Primary debulking surgery is still the gold standard treatment. As long as optimal debulking is feasible in EOC, NACT-IDS can be considered for patients where optimal debulking is not possible or surgery is risky due to various patient related/ tumor related factors.
Keywords: Primary Cytoreductive surgery (PS), Neoadjuvant Chemotherapy (NACT), Interval Debulking Surgery (IDS), Epithelial Ovarian Cancer (EOC).
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