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- Title
Primary cytoreductive surgery or neoadjuvant chemotherapy in advanced ovarian epithelial cancer?
- Authors
Subţirelu, G. D.; Marincaş, A. M.; Daha, C.; Cirimbei, C.; Brătucu, E.
- Abstract
Ovarian cancer is the fifth most common cancer in women and the fifth leading cause of cancer death in women. Approximately 90% of ovarian primary malignancies have epithelial origin (carcinomas), and 70% of patients with ovarian epithelial cancers present with advanced stages, which raises major therapeutic problems. Advanced ovarian epithelial cancer (AOEC) treatment pillars are surgery and chemotherapy. Primary cytoreductive surgery (PCS) aiming at complete resection (R0) followed by chemotherapy based on platinum salts and taxanes was the standard treatment in AOEC. PCS results in AOEC are usually evaluated according to the amount of residual disease remaining after surgery: no macroscopic residual disease or optimal cytoreduction if residual tumors ≤1 cm or suboptimal cytoreduction if residual tumors >1 cm; but recent striking differences were observed between R0 and cytoreduction with macroscopic residual tumors (no matter their size), survival remaining significantly higher for patients with macroscopic residual tumors ≤1cm. Material and method. This is a retrospective study performed on a group of 389 patients with AOEC, operated between 2005 and 2014, at the 1st Department of General and Oncologic Surgery, “Prof. Dr. Alex. Trestioreanu” Institute of Oncology Bucharest. We examined each case with regard to the therapeutic sequence - PCS or neoadjuvant chemotherapy (NAC) and cytoreductive surgery, stage, histopathological type, the grade of differentiation, extent of surgery and its complications, the chemotherapy regimen administered. We evaluated the rate of R0 resections, the overall survival (OS) and the progression-free survival according to therapeutic sequence - PCS or NAC and cytoreductive surgery, stage, histopathological type, and tumor grading. Conclusions. We have noticed that OS of patients with neoadjuvant chemotherapy (NAC) was not inferior to that of patients with PCS, and postoperative morbidity at the time of cytoreduction was not higher in patients with NAC. Given that the goal of surgery in the AOEC is R0, it is still to be assessed if the PCS should be recommended in patients in whom we expect to obtain R0 and, on the other hand, to determine the sequence and the regimens for patients in whom we do not expect a R0 at the PCS.
- Subjects
OVARIAN cancer treatment; CYTOREDUCTIVE surgery; CANCER chemotherapy
- Publication
Oncolog-Hematolog, 2017, Issue 39, p55
- ISSN
2066-8716
- Publication type
Abstract