Reply to W.R. Robinson from Chi: re: “Is the Easier Way Ever the Better Way? (ovarian cancer/neoadjuvant therapy/surgery/references...)

 Blogger's Note: follows to prior posting/correspondence/dialogue; worthwhile reading this discussion/debate, note the common denominator in references
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Reply to W.R. Robinson

Reply to W.R. Robinson

1. Dennis S. Chi⇓

1. Memorial Sloan-Kettering Cancer Center, New York, NY

1. Corresponding author: Dennis S. Chi, MD, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; e-mail: gynbreast@mskcc.org.

1. Robert E. Bristow

1. University of California, Irvine Medical Center, Orange, CA

1. Deborah K. Armstrong

1. Johns Hopkins Kimmel Cancer Center, Baltimore, MD

1. Beth Y. Karlan

+ Author Affiliations

1. Cedars-Sinai Medical Center, Los Angeles, CA

We thank Robinson¹ for his comments on our editorial, “Is the Easier Way Ever the Better Way?”² Robinson disagreed with our article on two points. First, he stated that it is “both disingenuous and unrealistic to… suggest that fellowship-trained, Board-certified gynecologic oncologists are not capable of operating on women with advanced ovarian cancer.” Robinson also expressed concern that we were suggesting that neoadjuvant chemotherapy (NACT) “somehow represents a failure on the part of the physicians who are taking ‘the easy way out.'”

To the first point, we did not say that fellowship-trained, Board-certified gynecologic oncologists are not capable of operating on women with advanced ovarian cancer. Rather, we wanted to highlight that the number of patients who receive suboptimal debulking could be reduced by collaboration with other surgical colleagues. Many gynecologic oncologists partner with urologists for complex continent urinary conduits after pelvic exenteration and with plastic surgeons for a myocutaneous flap after radical pelvic surgery, for example, and we believe that patients with ovarian cancer should also be offered the potential benefit of subspecialty surgical consultation if it will improve their overall survival. The complexity of preplanning surgical consultations for advanced ovarian cancer debulking surgery should not be any different than for these other surgical collaborations.

It is incumbent on the gynecologic oncologist to ensure that pressures to minimize operating room and intensive care unit usage do not compromise the surgical outcome for our patients.........

The author(s) indicated no potential conflicts of interest.

Previous Section

 

REFERENCES

1. ↵
   1. Robinson WR

   (2012) Neoadjuvant chemotherapy is rarely the easy way out. J Clin Oncol 30:1563.

   FREE Full Text
2. ↵
   1. Chi DS,
   2. Bristow RE,
   3. Armstrong DK,
   4. et al.

   (2011) Is the easier way ever the better way? J Clin Oncol 29:4073–4075.

   FREE Full Text
3. ↵
   1. Chi DS,
   2. Musa F,
   3. Dao F,
   4. et al.

   (2012) An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT) Gynecol Oncol 124:10–14.

   CrossRefMedline
4. ↵
   1. Vergote I,
   2. Tropé CG,
   3. Amant F,
   4. et al.

   (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943–953.

   CrossRefMedline
5. ↵
   1. Tiersten AD,
   2. Liu PY,
   3. Smith HO,
   4. et al.

   (2009) Phase II evaluation of neoadjuvant chemotherapy and debulking followed by intraperitoneal chemotherapy in women with stage III and IV epithelial ovarian, fallopian tube or primary peritoneal cancer: Southwest Oncology Group Study S0009. Gynecol Oncol 112:444–449.

   CrossRefMedline
6. ↵
   1. Chi DS,
   2. Eisenhauer EL,
   3. Zivanovic O,
   4. et al.

   (2009) Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol 114:26–31.

   CrossRefMedline

Correspondence: Neoadjuvant Chemotherapy (ovarian cancer) Is Rarely the Easy Way Out + references +discussion on gyn specialists/general surgeons

Blogger's Note: worthwhile reading/pondering...
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Neoadjuvant Chemotherapy Is Rarely the Easy Way Out

 To the Editor:

I appreciate the thoughtful analysis by Chi et al¹ in the November 1 issue of Journal of Clinical Oncology, in the article entitled, “Is the Easier Way Ever the Better Way?” Chi et al make a very literate argument against using neoadjuvant chemotherapy (NACT) for ovarian cancer, continuing a discussion that has lingered among oncologists for more than 25 years. The argument has heated up recently as a result of several prospective studies, particularly that of Vergote et al,² which showed no difference in survival in patients treated with either primary surgery or NACT.

I must, however, disagree with Chi et al¹ on two points. The first of these is the suggestion by the authors that patients with stage IIIC/IV ovarian cancer should routinely be referred to ultraspecialist centers that are capable of performing advanced upper abdominal surgery. In reality, the great majority of patients with ovarian cancer in the United States have been and will be treated in community settings for the foreseeable future. The professional societies that represent gynecologic oncology have for years strongly recommended that ovarian cancer be handled by fellowship-trained gynecologic oncologists. This effort has met with mixed success; in many communities it is still the norm for women with advanced ovarian cancer to be operated on by physicians with no special oncologic surgical training.......

plus references:

REFERENCES

1. ↵
   1. Chi DS,
   2. Bristow RE,
   3. Armstrong DK,
   4. et al.

   (2011) Is the easier way ever the better way? J Clin Oncol 29:4073–4075.

   FREE Full Text
2. ↵
   1. Vergote I,
   2. Tropé GC,
   3. Amant F,
   4. et al.

   (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943–953.

   CrossRefMedline
3. ↵
   1. Tiersten AD,
   2. Liu PY,
   3. Smith HO,
   4. et al.

   (2009) Phase II evaluation of neoadjuvant chemotherapy and debulking followed by intraperitoneal chemotherapy in women with stage III and IV epithelial ovarian, fallopian tube or primary peritoneal cancer: Southwest Oncology Group Study S0009. Gynecol Oncol 112:444–449.

   CrossRefMedline