Retrospective Study Comparing Primary Debulking Surgery (PDS) with Adjuvant Chemotherapy vs. Neoadjuvant Chemotherapy (NACT) Followed by Interval Debulking Surgery (IDS) with Adjuvant Chemotherapy in Advanced Carcinoma Ovary
Journal Title: International Journal of Contemporary Medical Research - Year 2016, Vol 3, Issue 1
Abstract
Introduction: Ovarian carcinoma is the major cause of mortality among women with gynecological problems as its reported very late. We have evaluated and compared two modalities of treatment for advanced (stage III and selected stage IV) ovarian cancer, done at our hospital from January 2003 to June 2010 and also analyzed patient, tumour, and treatment related variables. Materials and Methods: Records of 72 patients of advanced epithelial ovarian cancer were reviewed. Arm1 included 32 patients who underwent primary debulking surgery (PDS)->adjuvant chemotherapy (6cycles). Arm 2 included 40patients who were given neoadjuvant chemotherapy (NACT) (average2-4cycles)->response assessed->interval debulking surgery(IDS) in responders-> adjuvant chemotherapy(rest2-4cycles). Chemotherapy (both NACT and Adj.CT) given was Cisplatin (intravenous)–75mg/m2 +Paclitaxel(intravenous)-175mg/m2 over 3hrs with adequate hydration and premedication. Repeated every 3 weeks. Results: There were relatively elderly patients with higher stage and grade of disease in arm 2. In this arm, 75% patients responded and 25%didn’t respond to NACT. Optimal cytoreduction was possible significantly more in Arm2 (83.3%) patients compared to Arm1 (53.1%) patients and also with comparatively less perioperative morbidity and mortality. With median follow-up of 39 months, median disease-free, progression-free and overall survival were same with more systemic recurrences in arm1. Conclusion: In this study, we found that in ovarian cancer, NACT has good response rate. It significantly increases optimum cytoreductive surgery rate, that too with less aggressive approach, morbidity and mortality. Although, there was no significant gain in survival, but an alternative approach of NACT->Surgery->Adj.CT, which gives equivalent survival to conventional approach of primary debulking surgery, can be considered equal or, even better especially in poor prognostic patients.
Authors and Affiliations
Mohammad Shadab Alam, Roshan Perween, Shahid A Siddiqui
Keywords
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