Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Sunday, September 11, 2016

Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States



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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