Source: DGNews  |  Posted 2 years ago

By Jill Stein

CHICAGO -- October 14, 2009 -- Neoadjuvant upfront platinum-based chemotherapy
appears to be superior to primary debulking surgery for achieving optimal
cytoreduction in women with advanced epithelial ovarian cancer, according to a
study presented here October 12 at the American College of Surgeons (ACS) 95th
Annual Clinical Congress.

Sukamal Saha, MD, McLaren Regional Medical Center, Flint, Michigan, and
colleagues reviewed the medical records of 86 consecutive women with stage IIIC
and IV ovarian cancer.

The study aimed to compare multiple outcome measures in women undergoing
neoadjuvant upfront chemotherapy and women undergoing primary debulking surgery
followed by adjuvant chemotherapy. Primary debulking surgery has been used to
achieve optimal cytoreduction in advanced epithelial cancer as the first line
of treatment.

Of the study participants, 46 had bulkier disease and were treated with
neoadjuvant upfront platinum-based chemotherapy with a median of 3 treatment
cycles, followed by surgery, and then a median of 3 additional treatment cycles.

The other 40 patients underwent primary debulking surgery followed by a median
of 6 cycles of platinum-based chemotherapy.

The 2 treatment groups were similar with respect to histology type. Serous
histology was the most common type in both groups.

CA-125 levels and the percentage of patients with stage III disease was
significantly higher in the group receiving neoadjuvant chemotherapy, thereby
indicating more aggressive disease.

Women were followed for at least 12 months.

The study found that neoadjuvant chemotherapy was associated with decreased
length of stay (8 vs 10 days) and less intraoperative blood loss (400 vs 700
cc; P = .003).

Overall, 93% of patients treated with neoadjuvant chemotherapy achieved optimal
cytoreduction compared with 63% of patients treated with primary debulking
surgery (P = .001). Optimal cytoreduction was defined as residual
tumour <1 cm after surgery.

The 2 groups had similar rates of recurrent disease (63% and 62%; P
= 1.0).

Neoadjuvant chemotherapy produced higher disease-free survival rates than
primary debulking surgery in stage IIIC and stage IV patients.

Dr. Saha said that further prospective randomised, controlled trials are needed
to confirm the results.

Presentation title: The Role of Neoadjuvant (Upfront) Chemotherapy
in Advanced Epithelial Ovarian Cancer as Compared to Primary Debulking Surgery.
Abstract SE153-M