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]
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