Hiroko Machida1, Hideki Tokunaga2, Koji Matsuo3, Noriomi Matsumura4, Yoichi Kobayashi5, Tsutomu Tabata6, Masanori Kaneuchi7, Satoru Nagase8, Mikio Mikami9. 1. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Japan. 2. Department of Obstetrics and Gynecology, Tohoku University, Japan. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, USA. 4. Department of Obstetrics and Gynecology, Kinki University, Japan. 5. Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Japan. 6. Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Japan. 7. Department of Obstetrics and Gynecology, Otaru General Hospital, Japan. 8. Department of Obstetrics and Gynecology, Yamagata University School of Medicine, Japan. 9. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Japan; Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan. Electronic address: mmikami@is.icc.u-tokai.ac.jp.
Abstract
OBJECTIVE: To compare the effectiveness and safety of neoadjuvant chemotherapy with carboplatin/paclitaxel followed by interval debulking surgery (NACT-IDS) to primary debulking surgery plus postoperative chemotherapy (PDS) for advanced ovarian cancer. METHODS: A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Ovarian Cancer Committee. Multiple public search engines including PubMed/MEDLINE and the Cochrane Database, were searched in March 2019 using the entry keywords "ovarian cancer [all fields]" AND "interval debulking surgery [all fields]", AND "neoadjuvant chemotherapy [all fields]". Key inclusion criteria were prospective clinical trials examining platinum-based NACT for stage II-IV epithelial ovarian cancer. The primary outcome of interest was survival, and the secondary outcome was adverse events with each intervention. RESULTS: After screening 333 studies, four phase III randomized clinical trials were identified that met the inclusion criteria. These trials included 1692 women (847 receiving NACT-IDS and 845 receiving PDS). It was found that NACT-IDS and PDS had similar overall survival (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.87-1.07, P = 0.53) and progression-free survival (HR: 0.98, 95%CI: 0.90-1.08, P = 0.74). In contrast, NACT-IDS was associated with significantly lower rates of perioperative complications (odds ratio [OR] 0.27, 95%CI: 0.20-0.36, P < 0.001) and perioperative mortality (OR: 0.17, 95%CI: 0.06-0.50, P < 0.001) compared to PDS. CONCLUSION: This systematic review and meta-analysis suggests that NACT-IDS with carboplatin and paclitaxel does not negatively impact the survival of women with advanced ovarian cancer compared to PDS, while perioperative complications and mortality are significantly reduced by 70-80%.
OBJECTIVE: To compare the effectiveness and safety of neoadjuvant chemotherapy with carboplatin/paclitaxel followed by interval debulking surgery (NACT-IDS) to primary debulking surgery plus postoperative chemotherapy (PDS) for advanced ovarian cancer. METHODS: A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Ovarian Cancer Committee. Multiple public search engines including PubMed/MEDLINE and the Cochrane Database, were searched in March 2019 using the entry keywords "ovarian cancer [all fields]" AND "interval debulking surgery [all fields]", AND "neoadjuvant chemotherapy [all fields]". Key inclusion criteria were prospective clinical trials examining platinum-based NACT for stage II-IV epithelial ovarian cancer. The primary outcome of interest was survival, and the secondary outcome was adverse events with each intervention. RESULTS: After screening 333 studies, four phase III randomized clinical trials were identified that met the inclusion criteria. These trials included 1692 women (847 receiving NACT-IDS and 845 receiving PDS). It was found that NACT-IDS and PDS had similar overall survival (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.87-1.07, P = 0.53) and progression-free survival (HR: 0.98, 95%CI: 0.90-1.08, P = 0.74). In contrast, NACT-IDS was associated with significantly lower rates of perioperative complications (odds ratio [OR] 0.27, 95%CI: 0.20-0.36, P < 0.001) and perioperative mortality (OR: 0.17, 95%CI: 0.06-0.50, P < 0.001) compared to PDS. CONCLUSION: This systematic review and meta-analysis suggests that NACT-IDS with carboplatin and paclitaxel does not negatively impact the survival of women with advanced ovarian cancer compared to PDS, while perioperative complications and mortality are significantly reduced by 70-80%.
Authors: Sean Kehoe; Jane Hook; Matthew Nankivell; Gordon C Jayson; Henry Kitchener; Tito Lopes; David Luesley; Timothy Perren; Selina Bannoo; Monica Mascarenhas; Stephen Dobbs; Sharadah Essapen; Jeremy Twigg; Jonathan Herod; Glenn McCluggage; Mahesh Parmar; Ann-Marie Swart Journal: Lancet Date: 2015-05-19 Impact factor: 79.321
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Authors: Leen Verleye; Petronella B Ottevanger; Gunnar B Kristensen; Tom Ehlen; Nick Johnson; Maria E L van der Burg; Nick S Reed; René H M Verheijen; Katja N Gaarenstroom; Berit Mosgaard; Jose M Seoane; Jacobus van der Velden; Robert Lotocki; Winette van der Graaf; Björn Penninckx; Corneel Coens; Gavin Stuart; Ignace Vergote Journal: Eur J Cancer Date: 2010-09-16 Impact factor: 9.162
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