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

IDS: interval debulking surgery; m = months; NACT: neoadjuvant chemotherapy; OS: overall survival; PFS: progression free survival; PPS: patient performance status; TFI: treatment free interval.