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Prognostic Significance of the Number of Postoperative Intraperitoneal Chemotherapy Cycles for Patients With Advanced Epithelial Ovarian Cancer
  1. Rudy S. Suidan, MD*,
  2. Qin Zhou, MA,
  3. Alexia Iasonos, PhD,
  4. Roisin E. O’Cearbhaill, MD,§,
  5. Dennis S. Chi, MD*,§,
  6. Kara C. Long Roche, MD*,
  7. Edward J. Tanner, MD*,
  8. John Denesopolis, BS*,
  9. Richard R. Barakat, MD*,§ and
  10. Oliver Zivanovic, MD, PhD*,§
  1. *Gynecology Service, Department of Surgery,
  2. Department of Epidemiology and Biostatistics, and
  3. Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and
  4. §Weill Cornell Medical College, New York, NY.
  1. Address correspondence and reprint requests to Oliver Zivanovic, MD, PhD, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-1320, New York, NY, 10065. E-mail: gynbreast{at}mskcc.org.
  1. Presented in part at the 45th Annual Meeting of the Society of Gynecologic Oncologists, Tampa, FL, March 22 to 25, 2014.

Abstract

Objective Phase 3 trials have demonstrated a survival advantage for patients with optimally debulked epithelial ovarian cancer who received intravenous (IV) and intraperitoneal (IP) chemotherapy compared with IV therapy alone. This was despite a significant proportion of patients in the IV/IP arms not completing all 6 planned cycles. Our objective was to evaluate the prognostic significance of the number of IV/IP cycles administered.

Methods/Materials Data were analyzed for all patients with stage III to IV epithelial ovarian cancer who underwent optimal primary cytoreduction followed by 1 or more cycles of IV/IP chemotherapy from January 2005 to July 2011 at our institution. A landmark analysis was performed to associate progression-free survival (PFS) and overall survival (OS) with the number of IV/IP cycles given.

Results We identified 201 patients; 26 (13%) received 1 to 2 cycles of IV/IP chemotherapy, 41 (20%) received 3 to 4 cycles, and 134 (67%) received 5 to 6 cycles. The 5-year PFS for patients who received 1 to 2, 3 to 4, and 5 to 6 cycles was 18%, 29%, and 17%, respectively. The 5-year OS for patients who received 1 to 2, 3 to 4, and 5 to 6 cycles was 44%, 54%, and 57%, respectively. There was no significant difference in PFS (P = 0.31) or OS (P = 0.14) between the 3 groups. The most common reason for discontinuing IV/IP therapy was treatment-related toxicity (77%). Postoperative complications were the most common reason for not initiating IV/IP therapy (42%) in patients who subsequently transitioned to it.

Conclusions We did not detect a significant survival difference between patients who received 1 to 2, 3 to 4, or 5 to 6 IV/IP chemotherapy cycles. Women may still derive a survival benefit if they receive fewer than 6 IV/IP cycles.

  • Ovarian cancer
  • Intraperitoneal chemotherapy
  • Progression-free survival
  • Overall survival

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Footnotes

  • Supported by the Roy M. Speer Foundation and the National Institutes of Health P30 CA008748 core grant.

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

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