Survival Outcomes from Delayed Cytoreduction Surgery Following Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

In patients with epithelial ovarian cancer, interval cytoreduction surgery generally follows 3 cycles of neoadjuvant chemotherapy. Surgery may be delayed in some patients resulting from incomplete disease response, poor surgical candidacy, or anticipated suboptimal tumor resectability. The optimal timing of cytoreductive surgery has not been established. Researchers sought to examine survival outcomes in patients with advanced epithelial ovarian cancer with respect to timing of surgery following neoadjuvant chemotherapy and the degree of cytoreduction performed.

Researchers performed a retrospective review of patients with endothelial ovarian cancer in whom complete cytoreduction was attained, based on the number of cycles of neoadjuvant chemotherapy patients had received. Overall survival and progression-free survival were analyzed in these patients and compared with data from patients with endothelial ovarian cancer who had only received chemotherapy. Outcome measures were correlated with the number of neoadjuvant chemotherapy cycles received and the amount of residual disease remaining following surgery.

A retrospective review was conducted of 572 patients with endothelial ovarian cancer treated with neoadjuvant chemotherapy and surgery between 2008 and 2017 and 99 patients treated with chemotherapy only. Among patients treated with neoadjuvant chemotherapy and surgery, the proportion of patients in whom complete cytoreduction was achieved was not related to the number of cycles of neoadjuvant chemotherapy patients received. For patients undergoing cytoreduction surgery following neoadjuvant chemotherapy, the median 5-year overall survival was 38 months. The progression-free survival for these patients was 24 months. There was no significant difference in overall survival between patients who had surgery following 3 cycles of neoadjuvant chemotherapy and those who had delayed surgery.

A significant overall survival advantage was associated with patients who underwent complete cytoreduction. For patients with no macroscopic disease, the median overall survival was 49 to 51 months, compared with 22 to 39 months for patients with <1 cm residual disease and 23 to 26 months for patients with residual disease measuring >1 cm. Surgery resulting in residual disease of >1 cm demonstrated no additional overall survival benefit compared with patients treated with chemotherapy alone.

Researchers conclude that in patients with endothelial ovarian cancer, survival outcomes do not appear to be worse for patients treated with neoadjuvant chemotherapy if cytoreduction surgery is delayed beyond 3 cycles. However, results of this review demonstrate that complete surgical cytoreduction, irrespective of surgical timing, is vital for best survival benefit.

Abstract 111. ESGO 2020.

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