Background: The standard treatment of advanced ovarian cancer [FIGO stage 3 and 4] has been complete cytoreductive surgery (CRS) followed by Platinum based chemotherapy. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (NACT/IDS) has been considered as an alternative to conventional PS in treating advanced EOC.

Objective: Analysis of survival and prognostic factors in advanced EOC patients who underwent Primary Cytoreductive surgery (PS) with Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (NACT/IDS)

Methods: A retrospective analysis of 25 patients who had advanced EOC surgery (stage 3 & 4) between the years 2005-2009. Clinicopathological, potential prognostic factors and progression-free survival (PFS) were analyzed.

Results: No significant difference was seen in the operative time, blood loss among PS and NACT-IDS group. Need for extensive surgeries which included bowel surgeries, diaphragm stripping/ resection, splenectomy, groin node debulking, pelvic/parietal peritonectomy was higher in PS group (53%) when compared to NACT-IDS group (35%).

In optimal cytoreductive group, when patients took complete chemotherapy, the median PFS was 21 months and in patients with incomplete chemotherapy it was 10 months(P=0.025).

In suboptimal cytoreductive group, when complete chemotherapy was taken ,the median PFS was 24 months when compared to 6 months in those who took incomplete chemotherapy(p=0.001). There was no difference in overall survival.

Conclusion: Though in many institutes, Primary debulking surgery is still the gold standard treatment. As long as optimal debulking is feasible in EOC, NACT-IDS can be considered for patients where optimal debulking is not possible or surgery is risky due to various patient related/ tumor related factors.

Keywords: Primary Cytoreductive surgery (PS),  Neoadjuvant Chemotherapy (NACT), Interval Debulking Surgery (IDS), Epithelial Ovarian Cancer (EOC).

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Dr Rajshekar. S Kunderagi

Department of Gynaec Oncology,

Kidwai Cancer Institute, Bangalore, India