abstract
Highlights
- •Treatment of advanced ovarian cancer with neoadjuvant chemotherapy became more frequent between 2004 and 2013
- •Utilization of neoadjuvant chemotherapy began to increase in 2007
- •Neoadjuvant chemotherapy was adopted most rapidly among elderly women, and those with stage IV ovarian cancer
Objective
Neoadjuvant
chemotherapy and interval debulking surgery for the treatment of
advanced ovarian cancer has remained controversial, despite the
publication of two randomized trials comparing this modality with
primary cytoreductive surgery. This study describes temporal trends in
the utilization of neoadjuvant chemotherapy and interval debulking
surgery in clinical practice in the United States.
Methods
We
completed a time trend analysis of the National Cancer Data Base. We
identified women with stage IIIC and IV epithelial ovarian cancer
diagnosed between 2004 and 2013. We categorized subjects as having
undergone one of four treatment modalities: primary cytoreductive
surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy
followed by interval debulking surgery, surgery only, and chemotherapy
only. Temporal trends in the frequency of treatment modalities were
evaluated using Joinpoint regression, and χ2 tests.
Results
We
identified 40,694 women meeting inclusion criteria, of whom 27,032
(66.4%) underwent primary cytoreductive surgery and adjuvant
chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and
interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%)
received chemotherapy only. The proportion of women receiving
neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6%
between 2004 and 2013 (p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p
= 0.001). During this period, the proportion of women who received
primary cytoreductive surgery and chemotherapy declined from 68.1% to
60.8% (p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% (p < 0.001).
Conclusion
Between
2004 and 2013 the frequency of neoadjuvant chemotherapy and interval
surgery increased significantly in the United States.
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