Treatment of FIGO stage IV ovarian carcinoma

Results of primary surgery or interval surgery after neoadjuvant chemotherapy: A retrospective study

Arash Rafii Tabrizi, B. Deval, J. F. Geay, N. Chopin, X. Paoletti, D. Paraiso, E. Pujade-Lauraine

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan-Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54%) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22%) patients had a simple biopsy, and 25 (24%) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95% confidence interval [CI], 19.5-29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95% CI, 5.4-24.9 months) than patients who had optimal primary surgery (22.9 months; 95% CI, 15.6-30.1 months), nonoptimal primary surgery (27.1 months; 95% CI, 21.2-32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95% CI, 23.5-67.5 months) (P =.001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.

Original languageEnglish
Pages (from-to)777-783
Number of pages7
JournalInternational Journal of Gynecological Cancer
Volume17
Issue number4
DOIs
Publication statusPublished - Jul 2007
Externally publishedYes

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Retrospective Studies
Carcinoma
Drug Therapy
Confidence Intervals
Therapeutics
Ovarian Neoplasms
Survival
Ovariectomy
Paclitaxel
Platinum
Hysterectomy
Biopsy

Keywords

  • Neoadjuvant chemotherapy
  • Stage IV ovarian cancers
  • Surgery

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology
  • Cancer Research

Cite this

Treatment of FIGO stage IV ovarian carcinoma : Results of primary surgery or interval surgery after neoadjuvant chemotherapy: A retrospective study. / Tabrizi, Arash Rafii; Deval, B.; Geay, J. F.; Chopin, N.; Paoletti, X.; Paraiso, D.; Pujade-Lauraine, E.

In: International Journal of Gynecological Cancer, Vol. 17, No. 4, 07.2007, p. 777-783.

Research output: Contribution to journalArticle

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abstract = "The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan-Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54{\%}) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22{\%}) patients had a simple biopsy, and 25 (24{\%}) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95{\%} confidence interval [CI], 19.5-29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95{\%} CI, 5.4-24.9 months) than patients who had optimal primary surgery (22.9 months; 95{\%} CI, 15.6-30.1 months), nonoptimal primary surgery (27.1 months; 95{\%} CI, 21.2-32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95{\%} CI, 23.5-67.5 months) (P =.001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.",
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