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Abstract
Introduction/Background The aim of this study was to compare the disease-free survival (DFS) and overall survival (OS) of patients who underwent interval cytoreductive surgery after 3–4 cycles or 6 cycles of neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer patients in whom primary cytoreductive surgery could not be performed.
Methodology Out of 219 patients with advanced epithelial ovarian cancer,123 patients received 3–4 cycles and 96 patients received 6 cycles of platinum based NACT. Afterwards, laparotomy was performed for interval cytoreductive surgery.
Results The disease-free survival and overall survival of patients were evaluated, no statistically significant difference was found when the patients who received 3–4 cycles of NACT and those who received 6 cycles of NACT were compared (HR:1.047, 95.0% CI [0.779–1.407]; p:0.746 for DFS, and HR:1.181, 95.0% CI[0.818–1.707]; p:0.368 for OS). Evaluating 123 patients who received 3–4 cycles of NACT; 87 patients (70.7%) without macroscopic residual tumor after interval cytoreductive surgery had significantly longer DFS and OS compared to 36 patients(29.3%) with any residual tumor (HR: 1.830, 95.0% CI [1.194- 2.806]; p:0.003 for DFS, and HR: 1.946, 95.0% CI [1.166–3.250]; p:0.009 for OS). Similarly, when 96 patients who received 6 courses of NACT were evaluated; 63 patients (65.6%) without macroscopic residual tumor after interval cytoreductive surgery had significantly longer DFS and OS than 33 patients (34.4%) with any residual tumor ( HR: 1.716, 95.0% CI [1.092–2.697];p:0.010 for DFS, and HR:1.921,95.0% CI [1.125–3.282] ; p:0.013 for OS).
Conclusion The most important factor determining survival is whether macroscopic residual tumor tissue remains after interval cytoreductive surgery following NACT. All kinds of aggressive surgical intervention should be performed to ensure optimal cytoreduction(r=0) after NACT.
A: DFS; 3–4 cycles of NACT versus 6 cycles of NACT in patients with no residual tumor. B: OS; 3–4 cycles of NACT versus 6 cycles of NACT in patients with no residual tumor.
Disclosures In patients with advanced ovarian cancer, there is no significant difference in DFS and OS between 3–4 cycles or 6 cycles of NACT.