Primary cytoreductive surgery (PCS) may improve survival for patients with stage III ovarian cancer, while neoadjuvant chemotherapy may be the optimal treatment for patients with stage IV disease, reported researchers in the Journal of Clinical Oncology, who examined the use and effectiveness of neoadjuvant chemotherapy in clinical practice.
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The observational study included 1538 women with stages IIIC and IV ovarian cancer who were treated at six National Cancer Institute-designated cancer centers between 2003 and 2012. Patients were assigned to neoadjuvant chemotherapy or PCS on the basis of whether they first received chemotherapy or surgery. In the first cohort, the researchers assessed neoadjuvant chemotherapy over time among 1538 patients diagnosed between 2003 and 2012 and treated within 12 weeks of diagnosis. In the second cohort, the investigators examined factors and outcomes associated with neoadjuvant chemotherapy vs PCS within a subset of 1158 patients from cohort 1, excluding patients who received intraperitoneal and intravenous chemotherapy.
The adoption of neoadjuvant chemotherapy increased steadily over time from 16% to 34% among patients with stage IIIC disease, and from 41% to 62% among patients with stage IV disease between 2003 and 2011. Patients with stage IIIC disease who received neoadjuvant chemotherapy had significantly decreased overall survival compared with those treated with PCS (median, 33 v 43 months), but there was no significant difference with stage IV disease (median, 31 vs 36 months).
The findings were consistent with a subset analysis in the EORTC study, which showed improved survival in patients with stage III ovarian cancer and £45 mm of disease in patients who received PCS vs chemotherapy. Additionally, the results are aligned with the recently published position statement from the American Society of Clinical Oncology and the Society of Gynecologic Oncology for neoadjuvant chemotherapy.—Eileeen Koutnik Fotopoulos
