B57: Interval or Late Debulking Surgeries in Advanced Epithelial Ovarian Cancer: Progression Free and Overall Survival Advantages
1Royal Stoke Hospital, Stoke-On-Trent, UK,2Mansoura University Oncology Centre, Mansoura, Egypt,3Mansoura University Public Health Department, Mansoura, Egypt
The best timing for cytoreductive surgery after neoadjuvant chemotherapy (NAC) in patients with advanced epithelial ovarian cancer (AEOC) is unclear. In our centre, patients with AEOC are commonly assessed for interval debulking surgeries (IDS) after 3 cycles of NAC or late debuking surgeries (LDS) after 6 cycles or otherwise no debulking surgeries (NDS) are considered.
This was a retrospective study of AEOC patients who had primary chemotherapy followed by debulking (IDS/LDS) or no debulking surgeries (NDS) in the Royal Stoke Hospital, between July 2009 and July 2014.
One hundred and eight patients were included; 64 (59.3%) had paclitaxel and carboplatin regimen and 44 (40.7%) carboplatin regimen. After 2 cycles of NAC 81 patients (75%) had partial response; 21 (19.4%) stable disease and 6 (5.6%) progressive disease. Forty one patients (38%) had IDS after cycle 3 and 11 patients (10.2%) had LDS after cycle 6 but 56 (51.8%) had NDS.
On further follow up, 95 patients (88%) relapsed. The median primary progression free survival (PFS) was 13 and 12 months for patients who had IDS and LDS respectively compared to 8 months for NDS. The 2 years PFS probability was 43% for patients who had IDS; 14% for LDS compared to 2% for NDS.
The median overall survival (OS) durations were 50, 33 and 17 months for patients who had IDS, LDS and NDS respectively. The 3 years OS probability was 60% for IDS patients; 50% for LDS compared to 15% for NDS.
In our study, longer durations and higher probabilities of PFS and OS were observed for patients who had IDS compared to those who had LDS or NDS. There is a need for improving NAC possibly with integrating target agents and the use of more intensified schedules aiming to increase the number of AEOC patients who can have debulking surgeries.