Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery(PDS) followed by adjuvant chemo...Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery(PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon's skill, infl uences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy(NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery(IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a defi nite benefi t of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or fi ndings from imaging studies may be predictive of resectability. However, no specific features have been consistently identifi ed in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.展开更多
Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy(NACT) and the prognostic factors for advanced epithelial ovarian cancer(EOC).Methods We enrolled 241 patients with s...Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy(NACT) and the prognostic factors for advanced epithelial ovarian cancer(EOC).Methods We enrolled 241 patients with stage III and IV EOC who were diagnosed at the Yunnan Cancer Hospital between October 2006 and December 2015.The observation(NACT-IDS) group(n = 119) received 1–3 courses of platinum-based NACT,followed by interval debulking surgery(IDS) and 6–8 courses of postoperative chemotherapy.The control group underwent primary debulking surgery(PDS)(n = 122) followed by 6–8 courses of postoperative chemotherapy.We analyzed the general conditions of the operations and the survival of both groups.Results Operating time,intraoperative blood loss and postoperative hospitalization were significantly lower in the NACT-IDS group(P < 0.05).The rate of optimal cytoreductive surgery was significantly higher in the NACT-IDS group(P < 0.05).A visible residual lesion was observed in 49(41.18%) and 48(40%) cases in the NACT-IDS and PDS groups,respectively,which were not significantly different(P > 0.05).The percentage of International Federation of Gynecology and Obstetrics(FIGO) stage IV tumors and the recurrence rates were significantly higher in the NACT-IDS group(P < 0.05).The mortality rates were 45.19%(47/104) and 35.19%(38/108) in the NACT-IDS and PDS groups,respectively(P > 0.05).Progression-free survival was 23.75 ± 9.98 and 23.57 ± 12.25 months in the NACT-IDS and PDS groups,respectively(P > 0.05).Overall survival(OS) was 31.11 ± 15.66 and 29.63 ± 18.00 months in the NACTIDS and PDS groups,respectively(P > 0.05).Optimal cytoreductive surgery with or without residual lesion was an independent influencing factor for advanced EOC in multivariate analysis.OS of patients treated with ≥8 courses of chemotherapy was significantly longer than those treated with < 8 courses.Conclusion NACT could improve the intra-and postoperative conditions in advanced EOC patients.Although the percentage of FIGO stage IV cancer was significantly higher in the NACT-IDS group,the prognosis was similar in both the NACT-IDS and PDS groups,suggesting that NACT improves the clinical outcome of advanced EOC.Optimal cytoreductive surgery with no residual lesion is a long-term protective factor in advanced EOC.At least 8 courses of chemotherapy overall or ≥ 6 courses postoperatively improves the OS.展开更多
Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor re...Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and significant increase progression-free survival and overall survival. Both responses to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian cancer.展开更多
Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the ...Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.展开更多
文摘Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery(PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon's skill, infl uences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy(NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery(IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a defi nite benefi t of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or fi ndings from imaging studies may be predictive of resectability. However, no specific features have been consistently identifi ed in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.
文摘Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy(NACT) and the prognostic factors for advanced epithelial ovarian cancer(EOC).Methods We enrolled 241 patients with stage III and IV EOC who were diagnosed at the Yunnan Cancer Hospital between October 2006 and December 2015.The observation(NACT-IDS) group(n = 119) received 1–3 courses of platinum-based NACT,followed by interval debulking surgery(IDS) and 6–8 courses of postoperative chemotherapy.The control group underwent primary debulking surgery(PDS)(n = 122) followed by 6–8 courses of postoperative chemotherapy.We analyzed the general conditions of the operations and the survival of both groups.Results Operating time,intraoperative blood loss and postoperative hospitalization were significantly lower in the NACT-IDS group(P < 0.05).The rate of optimal cytoreductive surgery was significantly higher in the NACT-IDS group(P < 0.05).A visible residual lesion was observed in 49(41.18%) and 48(40%) cases in the NACT-IDS and PDS groups,respectively,which were not significantly different(P > 0.05).The percentage of International Federation of Gynecology and Obstetrics(FIGO) stage IV tumors and the recurrence rates were significantly higher in the NACT-IDS group(P < 0.05).The mortality rates were 45.19%(47/104) and 35.19%(38/108) in the NACT-IDS and PDS groups,respectively(P > 0.05).Progression-free survival was 23.75 ± 9.98 and 23.57 ± 12.25 months in the NACT-IDS and PDS groups,respectively(P > 0.05).Overall survival(OS) was 31.11 ± 15.66 and 29.63 ± 18.00 months in the NACTIDS and PDS groups,respectively(P > 0.05).Optimal cytoreductive surgery with or without residual lesion was an independent influencing factor for advanced EOC in multivariate analysis.OS of patients treated with ≥8 courses of chemotherapy was significantly longer than those treated with < 8 courses.Conclusion NACT could improve the intra-and postoperative conditions in advanced EOC patients.Although the percentage of FIGO stage IV cancer was significantly higher in the NACT-IDS group,the prognosis was similar in both the NACT-IDS and PDS groups,suggesting that NACT improves the clinical outcome of advanced EOC.Optimal cytoreductive surgery with no residual lesion is a long-term protective factor in advanced EOC.At least 8 courses of chemotherapy overall or ≥ 6 courses postoperatively improves the OS.
文摘Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and significant increase progression-free survival and overall survival. Both responses to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian cancer.
文摘Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.
