OBJECTIVES: To examine the impact of delayed primary interval surgical debulking in women with ovarian cancer who show resistance to neoadjuvant platinum-based chemotherapy. METHODS: We carried out retrospective chart reviews to identify women treated for ovarian cancer between 1997 and 2005 who were resistant to neoadjuvant platinum-based chemotherapy based on CA-125 criteria. "Platinum resistance" was defined as having a decrease in serum CA-125 of less than 50% after three cycles of chemotherapy from the time of initial diagnosis. Associations between residual disease and platinum sensitivity status at time of first recurrence were identified using chi-square tests. Median progression-free interval was estimated using the Kaplan Meier method. RESULTS: Ninety-one women were treated with neoadjuvant chemotherapy. Seventeen patients met the criteria for platinum resistance after neoadjuvant chemotherapy. The mean decline in serum CA-125 levels was 18.2%. All patients underwent attempts at surgical debulking. Optimal debulking was achieved in 10 patients (59%). There was a significant association between decreasing amount of residual disease and improving clinical response after primary treatment (P=0.007), and with platinum sensitivity status at the time of first recurrence (P=0.023). The estimated median progression free survival was 10.7 months. CONCLUSION: In women with ovarian cancer who have demonstrated platinum resistance after primary neoadjuvant chemotherapy, optimal tumour debulking can further improve response to subsequent platinum-based chemotherapy and prognosis.
OBJECTIVES: To examine the impact of delayed primary interval surgical debulking in women with ovarian cancer who show resistance to neoadjuvant platinum-based chemotherapy. METHODS: We carried out retrospective chart reviews to identify women treated for ovarian cancer between 1997 and 2005 who were resistant to neoadjuvant platinum-based chemotherapy based on CA-125 criteria. "Platinum resistance" was defined as having a decrease in serum CA-125 of less than 50% after three cycles of chemotherapy from the time of initial diagnosis. Associations between residual disease and platinum sensitivity status at time of first recurrence were identified using chi-square tests. Median progression-free interval was estimated using the Kaplan Meier method. RESULTS: Ninety-one women were treated with neoadjuvant chemotherapy. Seventeen patients met the criteria for platinum resistance after neoadjuvant chemotherapy. The mean decline in serum CA-125 levels was 18.2%. All patients underwent attempts at surgical debulking. Optimal debulking was achieved in 10 patients (59%). There was a significant association between decreasing amount of residual disease and improving clinical response after primary treatment (P=0.007), and with platinum sensitivity status at the time of first recurrence (P=0.023). The estimated median progression free survival was 10.7 months. CONCLUSION: In women with ovarian cancer who have demonstrated platinum resistance after primary neoadjuvant chemotherapy, optimal tumour debulking can further improve response to subsequent platinum-based chemotherapy and prognosis.