Optimal timing of interval debulking surgery in advanced ovarian cancer: yet to be defined?

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 159; no. 2; pp. 407 - 412
• Main Authors: Stoeckle, Eberhard, Boubli, Benjamin, Floquet, Anne, Brouste, Véronique, Sire, Marie, Croce, Sabrina, Thomas, Laurence, Guyon, Frédéric
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.12.2011; Elsevier
• Subjects: Adolescent; Adult; Advanced ovarian carcinoma; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Cytoreductive surgery; Female; Female genital diseases; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Interval debulking surgery; Medical Records; Medical sciences; Middle Aged; Neo-adjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm Staging; Obstetrics and Gynecology; Ovarian neoplasm; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Prognosis; Remission Induction; Retrospective Studies; Survival Analysis; Time Factors; Timing of surgery; Tumors; Young Adult; Neo-adjuvant chemotherapy; Advanced ovarian carcinoma; Interval debulking surgery; Cytoreductive surgery; Ovarian neoplasm; Timing of surgery; Ovary carcinoma; Ovary cancer; Gynecology; Malignant tumor; Obstetrics; Female genital diseases; Ovary; Ovarian diseases; Chemotherapy; Treatment; Surgery; Timing; Cancer
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2011.07.014

Abstract Objectives Interval debulking surgery (IDS) following neo-adjuvant chemotherapy (NAC) is a treatment option in advanced ovarian cancer. It is recommended to perform IDS early, after 3 cycles of NAC, but late IDS (after 6 cycles) may yield better results. Delaying IDS, however, harbours the risk of loosing the opportunity for debulking surgery. Study design Retrospective comparison of two groups of patients with advanced ovarian carcinoma (stages IIC–IV) treated by platinum-based chemotherapy (CT) having undergone early IDS (after 3.6 cycles, group 1, n = 33) or late IDS (after 6.3 cycles, group 2, n = 104). Contemporary patients who had undergone standard treatment by primary debulking surgery (PDS) + CT (group 3, n = 446) and those treated by CT alone (group 4, n = 64 patients) served as internal controls. Results Prognosis in IDS patients (groups 1 + 2) was comparable to that in PDS patients (group 3). Only a few patients in group 4 potentially had lost an opportunity for debulking surgery. Groups 1 and 2 were well-matched concerning usual prognostic factors. Surgery extent and post-operative outcomes were similar in both. In contrast, complete cytoreductions were significantly more frequent in late than in early IDS (group 2 vs.1: 58% vs. 36%, p = 0.03) and survival was not inferior in the late IDS group compared to the early IDS group with 37 vs. 22 months, respectively ( p = 0.09). Conclusion Late IDS yields higher complete resection rates than early IDS and should be evaluated prospectively for outcome in further trials.