The optimal debulking after neoadjuvant chemotherapy in ovarian cancer: proposal based on interval look during upfront surgery setting treatment.

OBJECTIVE: The optimal goal of interval debulking surgery (IDS) following neoadjuvant chemotherapy (NAC) remains undefined. The aim of this study was to determine the optimal goal of IDS following NAC on the basis of long-term survival by the disease status at the end of interval look surgery (ILS) or IDS during the treatment in the setting of upfront primary debulking surgery (PDS).

METHODS: From January 1986 through December 2000, we performed treatment in the setting of upfront PDS in 128 patients with Stage III/IV epithelial ovarian cancer. Sixty-six patients with residual disease (RD) at PDS underwent interval surgery (IS) such as ILS or IDS; 4 patients after two cycles of chemotherapy and 62 after three or more cycles. We investigated how disease status at the end of IS was associated with overall survival (OS).

RESULTS: The 5-year OS rates for no, minimal and gross RD were not available (n = 0), 67% (n = 3) and 0% (n = 1) after two cycles, and 47% (n = 42), 0% (n = 18) and 0% (n = 2) after three or more cycles, respectively. No visible tumors at the end of IS after three or more cycles of chemotherapy were necessary for 5-year survival.

CONCLUSIONS: If the optimal goal of IDS is defined as the surgery that is expected to result in long-term survival in the NAC setting treatment, our data on the assessment of peritoneal findings during the upfront PDS setting treatment suggest that only complete resection with no RD could be the optimal goal of IDS in the NAC setting treatment.