Primary debulking surgery vs. neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Abstract

Objectives: To compare the survival of patients with stage IIIC or IV epithelial ovarian cancer (EOC) who were treated with neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS), and to investigate how to improve the survival of patients with advanced epithelial ovarian cancer.

Method: We retrospectively reviewed 339 patients with stage IIIC or IV EOC from January 2005 to December 2010 treated at West China Women's and Children's Hospital wherein 114 and 225 patients underwent NAC followed by IDS and PDS, respectively.

Results: No difference was observed in progression-free survival (PFS) or overall survival (OS) between NAC group and PDS group (PFS: 11 vs. 10 months, p = 0.629; OS: 25 vs. 25 months, p = 0.992). Patients with residual tumors that measured 0.1-1 cm at IDS following NAC had a statistically significant lower median OS compared to patients with no residual tumor, but comparable to that with residual tumors that measured >1 cm at IDS following NAC. The independent predictors of OS are size of residual tumor (p < 0.001), FIGO stage (p < 0.001), and age (p = 0.003).

Conclusions: NAC followed by IDS provides equal survival compared with PDS. Debulking to small residual tumors with a maximum diameter of less than 1 cm provides a smaller but still significant benefit for patients with PDS but a relatively minor effect with IDS following NAC. To improve the survival of patients with advanced ovarian cancer, the definition of "optimal" in IDS following NAC should be defined as no residual tumor.

Keywords: Debulking surgery; Neoadjuvant chemotherapy; Optimal; Ovarian cancer.