Research Article

Upfront cytoreductive surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer in Indian patients

*Author for correspondence:

E-mail Address: dr_mdray@yahoo.com

https://orcid.org/0000-0002-7059-5383

Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India

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Suryanarayana S.V. Deo

https://orcid.org/0000-0003-1955-8234

Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India

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Lalit Kumar

https://orcid.org/0000-0002-2418-9712

Department of Medical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India

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Manish Kumar Gaur

https://orcid.org/0000-0003-4403-9831

Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India

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Published Online:15 Jul 2021https://doi.org/10.2217/fon-2021-0077

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Abstract

In cases of ovarian carcinoma, primary cytoreductive surgery (CRS) is the standard treatment up to stage IIIB, but patient selection for neoadjuvant chemotherapy (NACT) in selected cases is controversial. A total of 200 patients with advanced ovarian cancer were analyzed retrospectively, according to specific selection criteria. Primary CRS was performed in 95 patients (47.5%) and interval CRS after 3–6 cycles of NACT was performed in 105 patients (52.5%). After median follow-up of 35 months, 5-year overall survival was 53.7% in the upfront CRS group and 42.2% in the NACT group. Primary CRS is the standard in advanced stages of ovarian carcinoma, but in certain subset of patients, NACT is preferred. Identifying that group is challenging but feasible. Proper selection of patients is key to successful outcomes.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

1. Ferlay J, Colombet M, Soerjomataram I et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int. J. Cancer 144(8), 1941–1953 (2019).
Medline CASGoogle Scholar
2. Halkia E, Spiliotis J. The role of cytoreductive surgery and HIPEC in epithelial ovarian cancer. J BUON. 20, S12–S28 (2015).
MedlineGoogle Scholar
3. Kusamura S, Sinukumar S, Baratti D, Guaglio M, Guadagni S, Deraco M. Cytoreductive surgery and HIPEC in the first-line and interval time points of advanced epithelial ovarian cancer. Indian J Gynecol Oncol. 15(S1), 11–20 (2017).
Google Scholar
4. Vergote I, De Wever I, Tjalma W, Van Gramberen M, Decloedt J, Van Dam P. Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol. Oncol. 71(3), 431–436 (1998).
Medline CASGoogle Scholar
5. Bhatt A, Sinukumar S, Rajan F et al. Impact of radicality versus timing of surgery in patients with advanced ovarian cancer (stage III C) undergoing CRS and HIPEC—a retrospective study by INDEPSO. Indian J Surg Oncol. 10(Suppl. 1), 57–64 (2019).
MedlineGoogle Scholar
6. Goldie JH CA. A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep. 63(11–12), 1727–1733 (1979).
Medline CASGoogle Scholar
7. Rauh-Hain JA, Rodriguez N, Growdon WB et al. Primary debulking surgery versus neoadjuvant chemotherapy in stage IV ovarian cancer. Ann. Surg. Oncol. 19(3), 959–965 (2012).
MedlineGoogle Scholar
8. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the Platinum Era: a meta-analysis. J. Clin. Oncol. 20(5), 1248–1259 (2002).
MedlineGoogle Scholar
9. Svs D, Hemant G, Nk S, Raina V, Lalit K, Srinivas G. Neoadjuvant chemotherapy followed by surgical cytoreduction in advanced epithelial ovarian cancer. Indian J. Cancer 43(3), 117–121 (2006).
MedlineGoogle Scholar
10. Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N. Engl. J. Med. 363(24), 2371 (2010). • First randomized controlled trial published for neoadjuvant chemotherapy versus primary surgery in advanced ovarian cancer.
Google Scholar
11. Kehoe S, Hook J, Nankivell M et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 386(9990), 249–257 (2015).
MedlineGoogle Scholar
12. Onda T, Satoh T, Ogawa G et al. Comparison of survival between primary debulking surgery and neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers in phase III randomised trial. Eur. J. Cancer 130(August 2019), 114–125 (2020).
Medline CASGoogle Scholar
13. Fagotti A, Ferrandina G, Vizzielli G et al. Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): final analysis of peri-operative outcome. Eur. J. Cancer 59, 22–33 (2016).
MedlineGoogle Scholar
14. Reuss A, Du Bois A, Harter P et al. TRUST: Trial of Radical Upfront Surgical Therapy in advanced ovarian cancer (ENGOT ov33/AGO-OVAR OP7). Int J Gynecol Cancer. 29(8), 1327–1331 (2019). • Ongoing trial examining the role of radical upfront surgical therapy in advanced ovarian cancer.
MedlineGoogle Scholar
15. Chi DS, Franklin CC, Levine DA et al. Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach. Gynecol. Oncol. 94(3), 650–654 (2004).
MedlineGoogle Scholar
16. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J. Clin. Oncol. 20(5), 1248–1259 (2002). • Metanalysis of the survival effect of maximal cytoreductive surgery in advanced ovarian cancer.
MedlineGoogle Scholar
17. Chang SJ, Bristow RE, Ryu HS. Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer. Ann. Surg. Oncol. 19(13), 4059–4067 (2012). •• Elucidates the impact of complete cytoreduction after maximal surgical effort on survival.
MedlineGoogle Scholar
18. Llueca A, Escrig J, Serra-Rubert A et al. Prognostic value of peritoneal cancer index in primary advanced ovarian cancer. Eur. J. Surg. Oncol. 44(1), 163–169 (2018). • Emphasizes the prognostic role of peritoneal cancer index in advanced ovarian cancer.
MedlineGoogle Scholar
19. Du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials. Cancer 115(6), 1234–1244 (2009).
MedlineGoogle Scholar
20. Llueca A, Climent MT, Escrig J et al. Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer. Sci Rep. 11(1), 1–8 (2021). •• Latest article in relation to predictive models for treatment guidance in advanced ovarian cancer.
MedlineGoogle Scholar
21. Llueca A, Serra A, Delgado K et al. A radiologic-laparoscopic model to predict suboptimal (or complete and optimal) debulking surgery in advanced ovarian cancer: a pilot study. Int J Womens Health. 11, 333–342 (2019).
MedlineGoogle Scholar
22. Gallotta V, Ferrandina G, Vizzielli G et al. Hepatoceliac lymph node involvement in advanced ovarian cancer patients: prognostic role and clinical considerations. Ann. Surg. Oncol. 24(11), 3413–3421 (2017).
MedlineGoogle Scholar
23. Gallotta V, Fanfani F, Fagotti A et al. Mesenteric lymph node involvement in advanced ovarian cancer patients undergoing rectosigmoid resection: prognostic role and clinical considerations. Ann. Surg. Oncol. 21(7), 2369–2375 (2014).
MedlineGoogle Scholar
24. Gallotta V, Fanfani F, Vizzielli G et al. Douglas peritonectomy compared to recto-sigmoid resection in optimally cytoreduced advanced ovarian cancer patients: analysis of morbidity and oncological outcome. Eur. J. Surg. Oncol. 37(12), 1085–1092 (2011).
Medline CASGoogle Scholar
25. Lu H, Cunnea P, Nixon K, Rinne N, Aboagye EO, Fotopoulou C. Discovery of a biomarker candidate for surgical stratification in high-grade serous ovarian cancer. Br. J. Cancer 124, 1286–1293 (2021). •• The discovery of a novel transcriptomic biomarker in high-grade ovarian cancer.
Medline CASGoogle Scholar
26. Lu H, Arshad M, Thornton A et al. A mathematical-descriptor of tumor-mesoscopic-structure from computed-tomography images annotates prognostic- and molecular-phenotypes of epithelial ovarian cancer. Nat Commun. 10(1), 1–11 (2019).
MedlineGoogle Scholar
27. Phelps DL, Borley JV, Flower KJ et al. Methylation of MYLK3 gene promoter region: a biomarker to stratify surgical care in ovarian cancer in a multicentre study. Br. J. Cancer 116(10), 1287–1293 (2017).
Medline CASGoogle Scholar

Vol. 17, No. 27

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History

Received 20 January 2021

Accepted 22 June 2021

Published online 15 July 2021

Published in print September 2021

Information

Keywords

Author contributions

MDR was responsible for study conception and design; MDR and MKG were responsible for acquisition of data; SVSD, LK, MDR and MKG were responsible for data analysis and drafting and revision of the manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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