Interval debulking surgery for advanced epithelial ovarian cancer | Cochrane Summaries updated/other similar reviews

Cochrane Summaries

Published Online: 

April 30, 2013

 

Ovarian cancer frequently presents at an advanced stage so it may not be possible to remove all tumours during surgery. Several cycles of chemotherapy are generally given after primary surgery. Secondary surgery, performed after a few cycles of chemotherapy before further cycles of chemotherapy, is called interval debulking surgery (IDS). This review compares the survival of women with advanced epithelial ovarian cancer, who had IDS performed between cycles of chemotherapy after primary surgery, with survival of women who had conventional treatment (primary debulking surgery and adjuvant chemotherapy). It found similar survival rates in women who did and did not receive IDS. Not enough information about adverse effects was available. Information on quality of life of the women was also inconclusive.

Background: 

Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option.

Objectives: 

To assess the effectiveness and complications of IDS for women with advanced stage epithelial ovarian cancer.

Selection criteria: 

Randomised controlled trials (RCTs) comparing survival of women with advanced epithelial ovarian cancer, who had IDS performed between cycles of chemotherapy after primary surgery with survival of women who had conventional treatment (primary debulking surgery and adjuvant chemotherapy).

Main results: 

Three RCTs randomising 853 women, of whom 781 were evaluated, met the inclusion criteria. Meta-analysis of three trials for overall survival (OS) found no statistically significant difference between IDS and chemotherapy alone (hazard ratio (HR) = 0.80, 95% confidence interval (CI) 0.61 to 1.06, I² = 58%). Subgroup analysis for OS in two trials, where the primary surgery was not performed by gynaecologic oncologists or was less extensive, showed a benefit of IDS (HR = 0.68, 95% CI 0.53 to 0.87, I² = 0%). Meta-analysis of two trials for PFS found no statistically significant difference between IDS and chemotherapy alone (HR = 0.88, 95% CI 0.57 to 1.33, I² = 83%). Rates of toxic reactions to chemotherapy were similar in both arms (risk ratio = 1.19, 95% CI 0.53 to 2.66, I² = 0%), but little information was available for other adverse events or quality or life (QoL).

Authors' conclusions: 

We found no conclusive evidence to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in women whose primary surgery was not performed by gynaecologic oncologists or was less extensive. Data on QoL and adverse events were inconclusive.

Assessed as up to date: 

March 5, 2013