abstract
(IDS = interval debulking surgery)
Highlights
- •Debulking surgery is not feasible for up to 20% of patients.
- •Chemotherapy alone can allow reasonable disease control in women unsuitable for IDS.
- •Carboplatin plus paclitaxel should be used when possible.
Objective
To
assess the outcome of patients with advanced ovarian cancer (OC) who
were treated without surgery, having received upfront chemotherapy and
no interval debulking surgery (IDS).
Methods
Retrospective
analysis of medical and chemotherapy records of consecutive patients
with OC between 2005 and 2013 at UCL Hospitals London, UK who received
neoadjuvant chemotherapy (NACT) was then found to be unsuitable for IDS
following review by the multidisciplinary team.
Results
Eighty-three
patients (18%) out of 467 receiving NACT did not undergo IDS. Median
age was 70 years (range 33–88); out of these 83 patients, 43 (51.8%)
presented with stage IV disease. Forty-three of these 83 patients
received carboplatin and paclitaxel (CP) (51.8%) and 37 received
carboplatin alone (C) (44.6%); 3 patients (3.6%) received other
platinum-based combinations. Reasons for not proceeding to surgery were:
poor response to chemotherapy after 3–4 cycles of NACT (61/83, 73.5%);
comorbidities (12/83, 14.5%); patient decision (4/83, 4.8%). Six
patients (7.2%) received <3
cycles of NACT due to a worsening clinical condition. The median
overall survival (OS) for patients not undergoing IDS was 18 months (95%
CI 10–20 months). Forty-four of 83 patients (53%) received >2 lines of chemotherapy. In a univariate analysis CP, age <70 years,
and absence of comorbidities were factors influencing OS. In a
multivariate analysis only having received CP remained independently
associated with OS (HR 0.49, 95% CI 0.29–0.84).
Conclusions
Chemotherapy alone can provide reasonable disease control in patients unsuitable for IDS and CP should be used if possible.
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