Review Article
When Should Surgical Cytoreduction in Advanced Ovarian Cancer Take Place?
Table 2
Nonrandomized case control studies evaluating delayed primary debulking surgery.
| Name of Study | Colombo et al. [10] | Oksefjell et al. [11] | Hegazy et al. [12] | Le T et al. [13] | Rafii et al. [14] | Vergote [15] |
| N | 203 | 789(217 IDS 572 non IDS) | 59 all submitted to prior surgical exploration | 61 | 109 | 285 |
| FIGO stage | IIc-IV | All stages treated for 1st relapse | II-IV | IV without bowel obstruction | IV | III-IV |
| Important study data | Gr 1 conventional OS = 38 m Gr 2 with NACT OS = 26 m | Platinum single or combination/taxol single or combinationor other | N = 27 (OS = 25 m) unresectable NACT with 18 for IDSN = 32 primary cytoreduction (OS = 28) | NACT platinum-taxol OS = 41.7 m | NACT platinum- taxol + IDSOS = 45.5 m (under 20% of patients in study) | Choice of treatment: upfront surgery or NACT according to disease extent and patient PPS |
| Main conclusions | Upfront surgery for advanced operable disease | Benefit of IDS versus chemotherapy alone when tumour is localised. | NACT for unresectable tumours leads to a group of sensitive patients for successful IDS | Response rate to NACT comparable to that of upfront surgery stated in literature | Benefit of IDS in patient responding to NACT | OS was higher for patients with high tumour load treated with NACT than with upfront surgery | NACT for non operable or poor performance status with IDS ideally after 3 cycles | Best OS (48 m) with radical primary cytoreduction, TFI >24 m & ≤ 39 years | Importance of maximal secondary cytoreduction in IDS | NACT can select patients for surgery |
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IDS: interval debulking surgery; m = months; NACT: neoadjuvant chemotherapy; OS: overall survival; PFS: progression free survival; PPS: patient performance status; TFI: treatment free interval.
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