Treatment strategies for patients with advanced ovarian cancer undergoing neoadjuvant chemotherapy: interval debulking surgery or additional chemotherapy?

• Published in: Journal of gynecologic oncology Vol. 30; no. 5; p. e81
• Main Authors: Yoneoka, Yutaka, Ishikawa, Mitsuya, Uehara, Takashi, Shimizu, Hanako, Uno, Masaya, Murakami, Takashi, Kato, Tomoyasu
• Format: Journal Article
• Language: English
• Published: Korea (South) Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 01.09.2019; 대한부인종양학회
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - metabolism; CA-125 Antigen - metabolism; Chemotherapy, Adjuvant; Cytoreduction Surgical Procedures - methods; Cytoreduction Surgical Procedures - mortality; Disease-Free Survival; Fallopian Tube Neoplasms - mortality; Fallopian Tube Neoplasms - therapy; Female; Humans; Membrane Proteins - metabolism; Middle Aged; Neoadjuvant Therapy; Original; Ovarian Neoplasms - mortality; Ovarian Neoplasms - therapy; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - therapy; Retrospective Studies; 산부인과학; Ovarian Neoplasm; Neoadjuvant Therapy; CA-125 Antigen; Cytoreduction Surgical Procedures
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2019.30.e81

To treat advanced ovarian cancer, interval debulking surgery (IDS) is performed after 3 cycles each of neoadjuvant chemotherapy (NAC) and postoperative chemotherapy (IDS group). If we expect that complete resection cannot be achieved by IDS, debulking surgery is performed after administering additional 3 cycles of chemotherapy without postoperative chemotherapy (Add-C group). We evaluated the survival outcomes of the Add-C group and determined their serum cancer antigen 125 (CA125) levels to predict complete surgery. A retrospective chart review of all stage III and IV ovarian, fallopian tube, and peritoneal cancer patients treated with NAC in 2007-2016 was conducted. About 117 patients comprised the IDS group and 26 comprised the Add-C group. Univariate and multivariate analyses revealed that Add-C group had an equivalent effect on progression-free survival (PFS; p=0.09) and overall survival (OS; p=0.94) compared with the IDS group. Multivariate analysis revealed that patients who developed residual disease after surgery had worse PFS (hazard ratio [HR]=2.18; 95% confidence interval [CI]=1.45-3.28) and OS (HR=2.33; 95% CI=1.43-3.79), and those who received <6 cycles of chemotherapy had worse PFS (HR=5.30; 95% CI=2.56-10.99) and OS (HR=3.05; 95% CI=1.46-6.38). The preoperative serum CA125 cutoff level was 30 U/mL based on Youden index method. Administering 3 additional cycles of chemotherapy followed by debulking surgery exhibited equivalent effects on survival as IDS followed by 3 cycles of postoperative chemotherapy. Preoperative serum CA125 levels of ≤30 U/mL may be a useful predictor of achieving complete surgery.