Liat Hogen, MD, FRCSC, gynecologic oncologist, Princess Margaret Cancer Center, assistant professor, Department of Obstetrics and Gynecology, University of Toronto, discusses the survival outcomes achieved with interval cytoreductive surgery (ICS) following neoadjuvant chemotherapy in a study of patients with initial unresectable stage IV ovarian cancer.

Due to disease location, volume, and other patient factors, primary cytoreductive therapy often does not produce responses in patients with stage IV epithelial ovarian cancer. These patients are instead treated with neoadjuvant chemotherapy followed by interval cytoreductive surgery. However, the favorability of ICS over chemotherapy alone has been under-investigated in patients who display residual disease after previous resection.

A retrospective analysis of patients with stage IV epithelial ovarian cancer was conducted to compare survival outcomes with neoadjuvant chemotherapy and ICS vs chemotherapy alone, and to determine the clinical or radiological factors that may prevent patients from undergoing ICS. Of the 111 patients in this study, 31% underwent primary cytoreductive surgery and were included in the overall survival (OS) analysis. However, these patients were not included in the outcome comparison, as they had the best OS prognosis. The percentage of patients underwent neoadjuvant chemotherapy and ICS was 58.6%, while 14% had chemotherapy alone due to ineligibility for ICS.

Results showed that 60% of patients exhibited supradiaphragmatic lymph nodes involvement, while 53% patients had pleural effusion. Liver parenchyma and inguinal lymph nodes were observed in 15% and 18.5% of patients, respectively. A small proportion of patients had parenchymal spleen, as well as brain or bone metastases.

Patients who underwent primary cytoreductive surgery obtained the highest median OS at 56 months. Of the remaining patients who received neoadjuvant chemotherapy and ICS vs chemotherapy only, OS prognosis was significantly higher in the former group. Notably, most patients who were initially found to express unresectable stage IV disease and received interval cytoreduction had no gross residual disease after surgery. Patient factors found to preclude patients from receiving ICS included old age, and the presence of multiple liver lesions.

Videos

Liat Hogen, MD, FRCSC, discusses the survival outcomes achieved with interval cytoreductive surgery following neoadjuvant chemotherapy in a study of patients with initial unresectable stage IV ovarian cancer.

Liat Hogen, MD, FRCSC

Articles

Dr Hogen on Survival Outcomes With Neoadjuvant Chemotherapy and ICS in Epithelial Ovarian Cancer