REPOST: open access: Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer — NEJM (multi-national study)

Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer — NEJM

Original Article

Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer

N Engl J Med 2010; 363:943-953September 2, 2010

Letters

In most women with ovarian carcinoma, the disease is not diagnosed until it is at an advanced stage. Primary cytoreductive surgery is considered the standard of care for advanced ovarian carcinoma.1-4 However, data from prospective, randomized, controlled trials assessing the role of primary surgery in the treatment of such cases are lacking. Interval debulking surgery has not been viewed as beneficial in women with residual tumor that exceeds 1 cm in diameter after primary debulking surgery performed with the objective of maximal surgical effort by a gynecologic oncologist.5-7 As an alternative to primary debulking surgery followed by chemotherapy, some authors have investigated the use of neoadjuvant chemotherapy before cytoreductive surgery. However, results of a meta-analysis involving 835 patients suggested that neoadjuvant chemotherapy, as compared with primary debulking surgery, was associated with a worse outcome.8
We report on a randomized trial in which we compared primary debulking surgery followed by platinum-based chemotherapy and platinum-based neoadjuvant chemotherapy followed by interval debulking surgery and additional platinum-based chemotherapy in women with advanced ovarian carcinoma.............

short (very) commentary: EORTC 55971: Does it apply to all patients with advanced state ovarian cancer?

Research Highlights
► Within this randomized trial a statistical benefit was seen with primary
surgery among patients with less than 5 cm of upper abdominal
disease (HR 0.64).
► Across different countries in this study there was significant
heterogeneity of the benefit of primary cytoreductive surgery.

refers to:
EORTC Newsletter Results of the EORTC 55971 trial: Neoadjuvant 
chemotherapy followed by interval debulking surgery is not inferior to 
primary debulking surgery followed by chemotherapy as a treatment 
option for patients with stage IIIC or IV ovarian carcinoma

Medical News:video (Dr Coleman) Similar Survival with Two Ovarian Cancer Strategies - in Oncology/Hematology, Ovarian Cancer from MedPage Today

"Patients with bulky, advanced ovarian cancer survived just as long whether treated with neoadjuvant chemotherapy and surgery or with primary surgery followed by adjuvant chemotherapy, investigators in a multinational trial reported."

"Subgroup analysis failed to identify any patient or tumor characteristics associated with better outcomes with one treatment strategy or the other. In both treatment groups, the success of cytoreductive surgery was the strongest predictor of survival."

Action Points

* Explain to interested patients that according to a recent randomized study, patients with bulky, advanced ovarian cancer survived just as long whether treated with neoadjuvant chemotherapy and surgery or with primary surgery followed by adjuvant chemotherapy


* Explain that both treatment strategies led to a median overall survival of about 30 months and median progression-free survival of 12 months.


Original Article
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer - NEJM

The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas

Objective.

To assess the morbidity and mortality associated with extensive upper abdominal surgery (EUAS) performed during primary cytoreduction for advanced ovarian carcinoma.