Synapse - Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center

Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center Journal Article

Authors:	Mueller, J. J.; Zhou, Q. C.; Iasonos, A.; O'Cearbhaill, R. E.; Alvi, F. A.; El Haraki, A.; Eriksson, A. G. Z.; Gardner, G. J.; Sonoda, Y.; Levine, D. A.; Aghajanian, C.; Chi, D. S.; Abu-Rustum, N. R.; Zivanovic, O.
Article Title:	Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center
Abstract:	Objective The aim of this study was to evaluate the use of neoadjuvant chemotherapy (NACT) and primary debulking surgery (PDS) before and after results from a randomized trial were published and showed non-inferiority between NACT and PDS in the management of advanced-stage ovarian carcinoma. Methods We evaluated consecutive patients with advanced-stage ovarian cancer treated at our institution from 1/1/08-5/1/13, which encompassed 32 months before and 32 months after the randomized trial results were published. We included all newly diagnosed patients with high-grade histology and stage III/IV disease. Associations between the use of NACT and clinical variables over time were evaluated. Results Our study included 586 patients. Median age was 62 years (range, 30-90); 406 patients (69%) had stage III disease, and 570 (97%) had disease of serous histology. Twenty-six percent (154/586) were treated with NACT and 74% (432/586) with PDS. NACT use increased significantly from 22% (56/256) before 2010 (at which point the results of the randomized trial were published) to 30% (98/330) after 2010 (p = 0.037). Although patients who underwent PDS were more likely to experience grade 3/4 surgical complications than those who underwent NACT, those selected for PDS had a median OS of 71.7 months (CI, 59.8-not reached) compared with 42.9 months (CI 37.1-56.3) for those selected for NACT. Conclusions In this single-institution analysis, the best survival outcomes were observed in patients who were deemed eligible for PDS followed by platinum-based chemotherapy. Selection criteria for NACT require further definition and should take institutional surgical strategy into account. © 2016 Elsevier Inc. All rights reserved.
Keywords:	overall survival; neoadjuvant chemotherapy; progression-free survival; primary debulking surgery; interval debulking surgery; advanced-stage ovarian cancer
Journal Title:	Gynecologic Oncology
Volume:	140
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2016-03-01
Start Page:	436
End Page:	442
Language:	English
DOI:	10.1016/j.ygyno.2016.01.008
PROVIDER:	scopus
PMCID:	PMC4767587
PUBMED:	26777991
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84959490540&partnerID=40&md5=c65a287b0087faf6d4582239ce934d58
Notes:	Article -- Export Date: 4 April 2016 -- Source: Scopus