Barry Rosen1, Stephane Laframboise1, Sarah Ferguson1, Jason Dodge1, Marcus Bernardini1, Joan Murphy1, Yakir Segev2, Ping Sun3, Steven A Narod4. 1. Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada. 2. Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada; Women's College Research Institute, Women's College Hospital, Familial Breast Cancer Research Unit, 790 Bay Street, Toronto, Ontario, M5G 1N8 Canada. 3. Women's College Research Institute, Women's College Hospital, Familial Breast Cancer Research Unit, 790 Bay Street, Toronto, Ontario, M5G 1N8 Canada. 4. Women's College Research Institute, Women's College Hospital, Familial Breast Cancer Research Unit, 790 Bay Street, Toronto, Ontario, M5G 1N8 Canada. Electronic address: steven.narod@wchospital.ca.
Abstract
OBJECTIVES: Women with advanced ovarian cancer are treated with chemotherapy either before (neoadjuvant) or after surgery (primary debulking). The goal is to leave no residual disease post-surgery; for women treated with primary debulking surgery this has been associated with an improvement in survival. It has not been shown that the survival advantage conferred by having no residual disease post-surgery is present for women who receive neoadjuvant chemotherapy. METHODS: We reviewed the records of 326 women with stage IIIc or IV serous ovarian cancer. We determined if they received neoadjuvant chemotherapy or primary debulking surgery and we measured the extent of residual disease post-surgery. We estimated seven-year survival rates for women after various treatments. RESULTS: Women who had neoadjuvant chemotherapy were more likely to have no residual disease than women who had primary debulking surgery (50.1% versus 41.5%; p=0.03) but they experienced inferior seven-year survival (8.6% versus 41%; p<0.0001). Among women who had primary debulking surgery, those with no residual disease had much better seven-year survival than women who had any residual disease (73.6% versus 21.0%; p<0.0001). Women who had no residual disease after debulking surgery and who received intraperitoneal chemotherapy had a seven-year survival of 90%. CONCLUSIONS: Neoadjuvant chemotherapy should be reserved for ovarian cancer patients who are not candidates for primary debulking surgery. Among women with no residual disease after primary debulking surgery, intraperitoneal chemotherapy extends survival.
OBJECTIVES:Women with advanced ovarian cancer are treated with chemotherapy either before (neoadjuvant) or after surgery (primary debulking). The goal is to leave no residual disease post-surgery; for women treated with primary debulking surgery this has been associated with an improvement in survival. It has not been shown that the survival advantage conferred by having no residual disease post-surgery is present for women who receive neoadjuvant chemotherapy. METHODS: We reviewed the records of 326 women with stage IIIc or IV serous ovarian cancer. We determined if they received neoadjuvant chemotherapy or primary debulking surgery and we measured the extent of residual disease post-surgery. We estimated seven-year survival rates for women after various treatments. RESULTS:Women who had neoadjuvant chemotherapy were more likely to have no residual disease than women who had primary debulking surgery (50.1% versus 41.5%; p=0.03) but they experienced inferior seven-year survival (8.6% versus 41%; p<0.0001). Among women who had primary debulking surgery, those with no residual disease had much better seven-year survival than women who had any residual disease (73.6% versus 21.0%; p<0.0001). Women who had no residual disease after debulking surgery and who received intraperitoneal chemotherapy had a seven-year survival of 90%. CONCLUSIONS: Neoadjuvant chemotherapy should be reserved for ovarian cancerpatients who are not candidates for primary debulking surgery. Among women with no residual disease after primary debulking surgery, intraperitoneal chemotherapy extends survival.
Authors: Deepa Magge; Lekshmi Ramalingam; Yongli Shuai; Robert P Edwards; James F Pingpank; Steven S Ahrendt; Matthew P Holtzman; Herbert J Zeh; David L Bartlett; Haroon A Choudry Journal: J Surg Oncol Date: 2017-06-19 Impact factor: 3.454
Authors: Shengqing Gu; Stephanie Lheureux; Azin Sayad; Paulina Cybulska; Liat Hogen; Iryna Vyarvelska; Dongsheng Tu; Wendy R Parulekar; Matthew Nankivell; Sean Kehoe; Dennis S Chi; Douglas A Levine; Marcus Q Bernardini; Barry Rosen; Amit Oza; Myles Brown; Benjamin G Neel Journal: Proc Natl Acad Sci U S A Date: 2021-06-22 Impact factor: 11.205