Neoadjuvant Chemo vs Primary Debulking Surgery in Epithelial Ovarian Cancer

11/06/17

A recent study assessed whether neoadjuvant chemotherapy is superior to primary debulking surgery with regard to mortality and quality of life for patients with advanced epithelial ovarian cancer.

Both neoadjuvant chemotherapy and primary debulking surgery have proven efficacy in patients with advanced epithelial ovarian cancer in prior studies. However, no studies have compared the two treatment options for perioperative morbidity, mortality, and quality of life in women with stage III-IV disease.

A group of Chinese researchers led by Yongxiu Yang, department of obstetrics and gynecology, The First Affiliated Hospital of Lanzhou University, conducted systematic reviews and meta-analyses to assess whether neoadjuvant chemotherapy is superior to primary debulking surgery with regard to optimal cytoreduction, perioperative morbidity, mortality, and quality of life in this disease setting. After searching PubMed, Embase, and a few other databases for randomized controlled trials comparing neoadjuvant chemotherapy and primary debulking surgery, researchers identified four trials involving 1607 patients.

Results of the study were published in PLOS One (online October 23, 2017; doi:10.1371/journal.pone.0186725).

Researchers found that compared with primary debulking surgery, neoadjuvant chemotherapy provided patients with a higher rate of complete cytoreduction (risk ratio [RR], 1.95; 95% CI, 1.33-2.87) and optimal cytoreduction (RR, 1.61; 95% CI, 1.05-2.47). However, no significant difference in residual disease of 0-1 cm was noted (P = .49).

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Additionally, researchers reported that neoadjuvant chemotherapy was associated with lower perioperative morbidity with respect to infection, gastrointestinal fistula, grade 3-4 adverse events, and less post-surgical death within 28 days.

After a 6-month follow-up period, neoadjuvant chemotherapy provided better quality of life than primary debulking surgery in relation to fatigue, role functioning, emotional functioning, and cognitive function.

Researchers concluded that neoadjuvant chemotherapy is superior to primary debulking surgery for patients with advanced epithelial ovarian cancer. Further research, they wrote, should focus on providing improvement of neoadjuvant chemotherapy efficacy.—Zachary Bessette