Clinical outcome of neoadjuvant chemotherapy for advanced ovarian cancer

abstract:
Clinical outcome of neoadjuvant chemotherapy for advanced ovarian cancer

Highlights

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Neoadjuvant chemotherapy (NACT) does not increase “platinum resistance”.

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Complete debulking after NACT has better outcome than residual disease after primary debulking.

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Inability to achieve complete surgical resection should be identified so that NACT may be offered.

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Objective

To evaluate clinical outcome in patients selected to receive neoadjuvant chemotherapy (NACT) compared to primary debulking surgery (PDS).

Methods

Retrospective study including all consecutive patients diagnosed and treated for advanced (stages III-IV) ovarian cancers between the years 2003–2015.

Results

263 women were included in the study, of these, 127 patients were selected to receive NACT and 136 were treated with PDS followed by adjuvant chemotherapy.

PDS was associated with longer OS in stage IIIc disease (median OS: 60.2 vs. 48.8 months; p-value 0.039) compared with NACT.

Patients achieved higher rates of complete cytoreduction in the NACT group compared to the PDS group (65.9% vs. 40.2%; p = 0.001). Patients attaining complete cytoreduction after PDS had the best survival, (median OS 106 months) followed by those with complete cytoreduction after NACT (median OS 71 months), followed by those with residual disease after PDS (median OS 55 months). Patients with residual disease following interval debulking after NACT had the worst outcome (median OS 36 months).

Platinum sensitivity following first line and second line chemotherapy was similar whether patients received neoadjuvant chemotherapy or not.

Conclusion

PDS was associated with improved outcome. NACT appears to improve survival outcome in patients that would have had residual disease after PDS, and attain complete cytoreduction at the time of interval cytoreduction. This treatment option can be used in selected patients that are not candidates for complete cytoreduction at PDS.