TITLE:
Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer
AUTHORS:
Amen Hamdy Zaky, Adel Gabr, Doaa Wadie Maximous, Ahmed A. S. Salem, Amr Farouk Mourad, Haisam Atta, Marwa Ismail
KEYWORDS:
Advanced Ovarian Cancer, Debulking Surgery, Neoadjuvant Chemotherapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.9 No.2,
February
26,
2018
ABSTRACT: Background: Inappropriately
ovarian cancer cannot be detected until an advanced
stage. Radical debulking surgery is considered the cornerstone in the
management of advanced ovarian cancer pointing to complete tumor resolution.
Unless optimal debulking cannot be achieved, these patients gain little benefit
from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel
therapeutic modality to a diversity of malignant tumors when the disease is not
willing to optimal surgical resection at the time of diagnosis or the patient
who unfit for aggressive debulking surgery. The purpose of this study is
to compare survival in the patient with advanced ovarian cancer (stage III/IV)
underwent primary debulking surgery followed by adjuvant chemotherapy
(PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased
in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR).
NACT-IDS showed significant improvement in progression-free survival (P-value
0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response
to NACT and residual volume were the two
independent prognostic factors for
overall survival. Conclusion: NACT-IDS
for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and
significant increase progression-free survival and overall survival. Both responses
to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian
cancer.