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The Impact of Number of Cycles of Neoadjuvant Chemotherapy on Survival of Patients Undergoing Interval Debulking Surgery for Stage IIIC–IV Unresectable Ovarian Cancer: Results From a Multi-Institutional Study
  1. Giorgio Bogani, MD, PhD*,
  2. Laura Matteucci, MD,
  3. Stefano Tamberi, MD,
  4. Valentina Arcangeli, MD,
  5. Antonino Ditto, MD*,
  6. Giuseppa Maltese, MD*,
  7. Mauro Signorelli, MD*,
  8. Fabio Martinelli, MD*,
  9. Valentina Chiappa, MD*,
  10. Umberto Leone Roberti Maggiore, MD*,
  11. Stefania Perotto, MD*,
  12. Cono Scaffa, MD, PhD*,
  13. Giuseppe Comerci, MD§,
  14. Marco Stefanetti, MD,
  15. Francesco Raspagliesi, MD* and
  16. Domenica Lorusso, MD, PhD*
  1. * Gynecologic Oncology, IRCCS National Cancer Institute, Milan;
  2. Medical Oncology, Ospedale degli Infermi, Faenza;
  3. Medical Oncology, Ospedale Infermi, Rimini;
  4. § Obstetrics and Gynecology, Ospedale S. Maria delle Croci, Ravenna; and
  5. Obstetrics and Gynecology, Ospedale Infermi, Rimini, Italy.
  1. Address correspondence and reprint requests to Domenica Lorusso, MD, PhD, Gynecologic Oncology, IRCCS National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. E-mail: domenica.lorusso{at}


Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes.

Methods Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated.

Results Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89–1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05–2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13–2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2–2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98–1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95–3.22; P = 0.06).

Conclusion Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

  • Ovarian cancer
  • Neoadjuvant chemotherapy
  • Interval debulking surgery
  • Number cycles

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  • The authors declare no conflict of interest.