[Re-evaluation of interval debulking surgery in advanced epithelial ovarian cancer]

Yu Ma, Yi Li, Heng Cui, Xu-dong Liang, Zhi-jian Tang, Xiao-ping Li, Yan Zhao, Li-hui Wei
Zhonghua Fu Chan Ke za Zhi 2012, 47 (5): 355-60

OBJECTIVE: Previous study showed that interval debulking surgery (IDS) may improve the survival of patients with advanced epithelial ovarian cancer (EOC). The precise significance of IDS needs to be evaluated.

METHODS: Totally 136 consecutive patients with stage IIIc or IV EOC (including primary peritoneal carcinoma and primary fallopian tube carcinoma) who completed primary debulking surgery (PDS) and platinum-based chemotherapy were enrolled from January 2000 to December 2009 in a retrospective cohort study. The study group was divided into three groups: 65 cases underwent optimal PDS (Group A), 41 cases received chemotherapy alone after suboptimal PDS (Group B), and 30 patients underwent IDS after suboptimal PDS (Group C). All patients received six to eight courses of platinum-based combination chemotherapy (paclitaxel plus carboplatin/cisplatin, cyclophosphamide plus epirubicin and cisplatin). Patients' clinical characteristics, perioperative situation and prognosis were compared.

RESULTS: Sixty-five cases (47.8%, 65/136) from 136 patients achieved optimal PDS. For Group C, 77% (23/30) patients obtained optimal debulking surgery after IDS. Intraoperative injury rates were similar between Group B and Group C (P > 0.05). Mild perioperative complications rate was also similar (P > 0.05). Median progression-free survival (PFS) of Group A was 26 months. Median overall survival (OS) of Group B and Group C were 31 months and 40 months, respectively (P = 0.254). Median PFS of Group B and Group C were 13 months and 24 months, respectively (P = 0.289). Although when it came to 20 months after PDS, patients who underwent IDS had a significantly lower progressive disease (PD) rate (Group B 33% versus Group C 61%, P = 0.046), it still showed that there was no significant difference in either OS or PFS of these two groups. Those patients in Group C who obtained no visible residual got similar PFS (27 months) comparing to Group A (26 months, P = 0.730), but OS was still shorter (P = 0.010).

CONCLUSIONS: For advanced EOC patients, IDS has little effect on improving survival. While it is safe and acceptable, also may prolong PFS in those patients who got no visible residual after IDS. The results suggest that IDS might be used as an alternative treatment for advanced EOC patients who cannot obtain optimal PDS in certain local hospitals.

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