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Ignace Vergote - One of the best experts on this subject based on the ideXlab platform.
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Primary surgery or neoadjuvant chemotherapy followed by interval Debulking surgery in advanced ovarian cancer.
European Journal of Cancer, 2011Co-Authors: Ignace Vergote, Frédéric Amant, Tom Ehlen, Gunnar B. Kristensen, Nicholas Reed, Antonio CasadoAbstract:Advanced ovarian cancer has a poor prognosis. De-bulking surgery and platinum-based chemotherapy are the cornerstones of the treatment. Primary Debulking surgery has been the standard of care in advanced ovarian cancer. Recently a new strategy with neoadjuvant chemotherapy followed by interval Debulking surgery has been developed. In a recently published randomised trial of the EORTC-NCIC (European Organisation for Research and Treatment of Cancer - National Cancer Institute Canada) in patients with extensive stage IIIc and IV ovarian cancer it was shown that the survival was similar for patients randomised to neoadjuvant chemotherapy followed by interval Debulking compared to primary Debulking surgery, followed by chemotherapy. The post-operative complications and mortality rates were lower after interval Debulking than after primary Debulking surgery. The most important independent prognostic factor for overall survival was no residual tumour after primary or interval Debulking surgery. In some patients obtaining the goal of no residual tumour at interval Debulking is difficult due to chemotherapy-induced fibrosis. On the other hand the patients randomised had very extensive stage IIIc and IV disease and in patients with metastases smaller than 5 cm the survival tended to be better after primary Debulking surgery. Hence, selection of the correct patients with stage IIIc or IV ovarian cancer for primary Debulking or neoadjuvant chemotherapy followed by interval Debulking surgery is important. Besides imaging with CT, diffusion MRI and/or PET-CT, also laparoscopy can play an important role in the selection of patients. It should be emphasised that the group of patients included in this study had extensive stage IIIc or IV disease. Surgical skills, especially in the upper abdomen, remain pivotal in the treatment of advanced ovarian cancer. However, very aggressive surgery should be tailored according to the general condition and extent of the disease of the patients. Otherwise, this type of aggressive surgery will result in unnecessary postoperative morbidity and mortality without improving survival. Hence, neoadjuvant chemotherapy should not be an easy way out, but is in some patients with stage IIIc or IV ovarian cancer a better alternative treatment option than primary Debulking. According to the current treatment algorithm at the University Hospitals Leuven about 50% of the patients with stage IIIc or IV ovarian cancer are selected for neoadjuvant chemotherapy.
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Comparison of diaphragmatic surgery at primary or interval Debulking in advanced ovarian carcinoma: an analysis of 163 patients.
European journal of cancer (Oxford England : 1990), 2010Co-Authors: Dimitris Tsolakidis, Frédéric Amant, Karin Leunen, Patrick Neven, Isabelle Cadron, Ignace VergoteAbstract:Abstract Aims of the study and methods Survival, complications and recurrences after diaphragmatic surgery at primary or interval Debulking surgery were compared. One hundred and sixty three consecutive patients with stage III/IV ovarian cancer underwent diaphragmatic surgery between September 1993 and December 2007. Primary Debulking was performed in group 1 (89) patients and interval Debulking was performed in group 2 (74) patients. Cytoreductive outcome, overall survival (OS), disease-free survival (DFS) and post-operative complications were analysed. Results Despite differences in baseline mean age (p = 0.015), in FIGO stage III/IV (p = 0.036) and in mean largest diameter of metastatic disease at the beginning of Debulking surgery (p = 0.037), the optimal Debulking rates (residual tumour less than 1 cm) were similar (p = 0.065). Excision of diaphragmatic metastases was most frequently performed in group 1 (77.53%) and coagulation was most frequently performed in group 2 (58.10%). Similar overall survival and disease-free survival rates were found. After the propensity matching procedure, the largest diameter of metastatic disease at the time of Debulking and no residual tumour (complete Debulking) were demonstrated as independent prognostic factors for OS. Plaque-like lesions on the diaphragm metastases were significantly (p = 0.015) more associated with diaphragm recurrence than papillary lesions. Minor and major complications related to diaphragmatic surgery as well as mean operating time, post-operative care in intensive care unit and length of hospitalisation were significantly higher in group 1 rather than in group 2 (p = 0.043). Conclusions Diaphragmatic dissemination resulted in similar survival and cytoreductive rates after primary and interval Debulking. However, the morbidity was less after interval Debulking as fewer surgical procedures were performed.
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neoadjuvant chemotherapy or primary surgery in stage iiic or iv ovarian cancer
The New England Journal of Medicine, 2010Co-Authors: Ignace Vergote, Frédéric Amant, Claes G Trope, Gunnar Kristensen, Tom Ehlen, Nick Johnson, Rene H M Verheijen, Maria E L Van Der Burg, A J Lacave, Pierluigi Benedetti PaniciAbstract:Of the 670 patients randomly assigned to a study treatment, 632 (94.3%) were eligible and started the treatment. The majority of these patients had extensive stage IIIC or IV disease at primary Debulking surgery (metastatic lesions that were larger than 5 cm in diameter in 74.5% of patients and larger than 10 cm in 61.6%). The largest residual tumor was 1 cm or less in diameter in 41.6% of patients after primary Debulking and in 80.6% of patients after interval Debulking. Postoperative rates of adverse effects and mortality tended to be higher after primary Debulking than after interval Debulking. The hazard ratio for death (intention-to-treat analysis) in the group assigned to neoadjuvant chemotherapy followed by interval Debulking, as compared with the group assigned to primary Debulking surgery followed by chemotherapy, was 0.98 (90% confidence interval [CI], 0.84 to 1.13; P = 0.01 for noninferiority), and the hazard ratio for progressive disease was 1.01 (90% CI, 0.89 to 1.15). Complete resection of all macroscopic disease (at primary or interval surgery) was the strongest independent variable in predicting overall survival. Conclusions Neoadjuvant chemotherapy followed by interval Debulking surgery was not inferior to primary Debulking surgery followed by chemotherapy as a treatment option for patients with bulky stage IIIC or IV ovarian carcinoma in this study. Complete resection of all macroscopic disease, whether performed as primary treatment or after neoadjuvant chemotherapy, remains the objective whenever cytoreductive surgery is performed. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00003636.)
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Timing of Debulking surgery in advanced ovarian cancer
International Journal of Gynecologic Cancer, 2008Co-Authors: Ignace Vergote, T Van Gorp, Frédéric Amant, Karin Leunen, Patrick Neven, Patrick BertelootAbstract:It is clear that primary Debulking remains the standard of care within the treatment of advanced ovarian cancer (FIGO stage III and IV). This Debulking surgery should be performed by a gynecological oncologist without any residual tumor load, or so-called "optimal Debulking." Over the last decades, interest in the use of neoadjuvant chemotherapy together with an interval Debulking has increased. Neoadjuvant therapy can be used for patients who are primarily suboptimally debulked due to an extensive tumor load. In this situation, based on the randomized European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group trial, interval Debulking by an experienced surgeon improves survival in some patients who did not undergo optimal primary Debulking surgery. Based on the GOG 152 data, interval Debulking surgery does not seem to be indicated in patients who underwent primarily a maximal surgical effort by a gynecological oncologist. Neoadjuvant chemotherapy can also be used as an alternative to primary Debulking. In retrospective analyses, neoadjuvant chemotherapy followed by interval Debulking surgery does not seem to worsen prognosis compared to primary Debulking surgery followed by chemotherapy. However, we will have to wait for the results of future randomized trials to know whether neoadjuvant chemotherapy followed by interval Debulking surgery is a good alternative to primary Debulking surgery in stage IIIc and IV patients. Open laparoscopy is probably the most valuable tool for evaluating the operability primarily or at the time of interval Debulking surgery.
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The role of interval Debulking surgery in ovarian cancer.
Current oncology reports, 2003Co-Authors: Maria E. L. Van Der Burg, Ignace VergoteAbstract:The mainstay of treatment for advanced ovarian cancer is the multimodality approach of Debulking surgery and paclitaxel— platinum chemotherapy. The size of residual lesions after primary surgery remains the most important prognostic factor for survival. Optimal primary Debulking surgery can be performed in approximately 40% of patients and up to 80% if it is done by gynecologic oncologists, but sometimes at the cost of considerable morbidity and even mortality. Based on a trial conducted by the European Organization for Research and Treatment of Cancer, optimal as well as suboptimal interval Debulking surgery increases overall (P=0.0032) and progression-free survival (P=0.0055). However, not all patients who have undergone suboptimal primary Debulking surgery seem to benefit from interval Debulking surgery. Preliminary data from the Gynecologic Oncology Group interval Debulking study (GOG-152) indicate that, if the gynecologic oncologist makes a maximal effort to resect the tumor, patients who have undergone suboptimal Debulking surgery probably gain little benefit from interval Debulking surgery.
John P. Curtin - One of the best experts on this subject based on the ideXlab platform.
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Timing is everything: intraperitoneal chemotherapy after primary or interval Debulking surgery for advanced ovarian cancer
Cancer chemotherapy and pharmacology, 2018Co-Authors: Jessica Lee, John P. Curtin, Franco M. Muggia, Bhavana Pothuri, Leslie R. Boyd, Stephanie V. BlankAbstract:Purpose To evaluate the outcomes of intraperitoneal chemotherapy (IP) compared with those of intravenous chemotherapy (IV) in patients with advanced ovarian cancer after neoadjuvant chemotherapy (NACT) and interval Debulking surgery (IDS) or primary Debulking surgery (PDS).
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Appropriate Recommendations for Surgical Debulking in Stage IV Ovarian Cancer.
Current treatment options in oncology, 2015Co-Authors: Jing-yi Chern, John P. CurtinAbstract:Epithelial ovarian cancer continues to be the leading cause of death due to gynecologic malignancy, and it is the fifth leading cause of cancer death in women in the USA and seventh worldwide. In most women with ovarian cancer, the disease is diagnosed at an advanced stage and primary cytoreductive surgery is considered standard of care. Traditionally, the gynecologic oncology literature supports the dictum that aggressive radical Debulking to reduce intra-abdominal tumor burden to minimal or less than 1 cm of disease has significant impact on overall survival. However, the European Organization for Research and Treatment of Cancer (EORTC) trial found that survival after neoadjuvant followed by interval Debulking surgery was similar to survival with the standard approach of primary surgery followed by chemotherapy. Many gynecologic oncologists have now adopted neoadjuvant chemotherapy for the treatment of stage IV ovarian cancer given the complex nature of this disease. Currently, there are conflicting results in the literature with regards to neoadjuvant chemotherapy versus primary Debulking for stage IV ovarian cancer. While there is evidence that neoadjuvant treatment is not inferior to primary Debulking, the literature also supports that maximizing Debulking efforts with radical surgery can provide a survival benefit in patients with stage IV ovarian carcinoma.
Steven A Narod - One of the best experts on this subject based on the ideXlab platform.
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a comparison of survival outcomes in advanced serous ovarian cancer patients treated with primary Debulking surgery versus neoadjuvant chemotherapy
International Journal of Gynecological Cancer, 2017Co-Authors: Taymaa May, Robyn Comeau, Ping Sun, Joanne Kotsopoulos, Steven A Narod, Barry P Rosen, Prafull GhatageAbstract:Objective The management of women with advanced-stage serous ovarian cancer includes a combination of surgery and chemotherapy. The choice of treatment with primary Debulking surgery or neoadjuvant chemotherapy varies by institution. The objective of this study was to report 5-year survival outcomes for ovarian cancer patients treated at a single institution with primary Debulking surgery or neoadjuvant chemotherapy. Methods This study included a retrospective chart review of 303 patients with stage IIIC or IV serous ovarian carcinoma diagnosed in Calgary, Canada. The patients were categorized into 1 of the 2 treatment arms: primary Debulking surgery or neoadjuvant chemotherapy. The 5-year ovarian cancer–specific survival rates were estimated using Kaplan-Meier curves. Results Among the 303 eligible patients, 142 patients (47%) underwent primary Debulking surgery, and 161 patients (53%) were treated with neoadjuvant chemotherapy. Five-year survival was better for patients undergoing primary Debulking surgery (39%) than for patients who received neoadjuvant chemotherapy (27%; P = 0.02). Women with no residual disease experienced better overall survival than those with any residual disease (47% vs. 26%, respectively; P = 0.0002). This difference was significant for those who had primary Debulking surgery (P = 0.0004) but not for the patients who received neoadjuvant chemotherapy (P = 0.09). Women who received intraperitoneal chemotherapy had better overall survival as compared with patients who received intravenous chemotherapy (44% vs 30%, respectively; P = 0.002). Conclusions Our findings suggest that among women with no residual disease, survival is better among those who undergo primary Debulking surgery than treatment with neoadjuvant chemotherapy. The latter should be reserved for women who are deemed not to be candidates for primary Debulking surgery.
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The impacts of neoadjuvant chemotherapy and of Debulking surgery on survival from advanced ovarian cancer.
Gynecologic oncology, 2014Co-Authors: Barry P Rosen, Ping Sun, Stephane Laframboise, Sarah E. Ferguson, Jason Dodge, Marcus Q. Bernardini, Joan Murphy, Yakir Segev, Steven A NarodAbstract:Abstract Objectives Women with advanced ovarian cancer are treated with chemotherapy either before (neoadjuvant) or after surgery (primary Debulking). The goal is to leave no residual disease post-surgery; for women treated with primary Debulking surgery this has been associated with an improvement in survival. It has not been shown that the survival advantage conferred by having no residual disease post-surgery is present for women who receive neoadjuvant chemotherapy. Methods We reviewed the records of 326 women with stage IIIc or IV serous ovarian cancer. We determined if they received neoadjuvant chemotherapy or primary Debulking surgery and we measured the extent of residual disease post-surgery. We estimated seven-year survival rates for women after various treatments. Results Women who had neoadjuvant chemotherapy were more likely to have no residual disease than women who had primary Debulking surgery (50.1% versus 41.5%; p =0.03) but they experienced inferior seven-year survival (8.6% versus 41%; p p Conclusions Neoadjuvant chemotherapy should be reserved for ovarian cancer patients who are not candidates for primary Debulking surgery. Among women with no residual disease after primary Debulking surgery, intraperitoneal chemotherapy extends survival.
John O. Schorge - One of the best experts on this subject based on the ideXlab platform.
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Primary Debulking Surgery Versus Neoadjuvant Chemotherapy in Stage IV Ovarian Cancer
Annals of surgical oncology, 2011Co-Authors: J. Alejandro Rauh-hain, Whitfield B Growdon, Neil S Horowitz, Noah Rodriguez, Annekathryn Goodman, David M. Boruta, Marcela G. Del Carmen, John O. SchorgeAbstract:Purpose Primary Debulking surgery (PDS) has historically been the standard treatment for advanced ovarian cancer. Recent data appear to support a paradigm shift toward neoadjuvant chemotherapy with interval Debulking surgery (NACT-IDS). We hypothesized that stage IV ovarian cancer patients would likely benefit from NACT-IDS by achieving similar outcomes with less morbidity.
Anna Fagotti - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of primary Debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer scorpion nct01461850
International Journal of Gynecological Cancer, 2020Co-Authors: Anna Fagotti, Giuseppe Vizzielli, P A Margariti, Francesco Fanfani, Maria Gabriella Ferrandina, T Pasciuto, Valerio Gallotta, Vito Chiantera, Barbara Costantini, Salvatore Gueli AllettiAbstract:Objective To investigate whether neoadjuvant chemotherapy followed by interval Debulking surgery is superior to primary Debulking surgery in terms of perioperative complications and progression-free survival, in advanced epithelial ovarian, fallopian tube or primary peritoneal cancer patients with high tumor load. Methods Patients with advanced epithelial ovarian, fallopian tube or primary peritoneal cancer (stage IIIC-IV) underwent laparoscopy. Patients with high tumor load assessed by a standardized laparoscopic predictive index were randomly assigned (1:1 ratio) to undergo either primary Debulking surgery followed by adjuvant chemotherapy (arm A), or neoadjuvant chemotherapy followed by interval Debulking surgery and adjuvant chemotherapy (arm B). Co-primary outcome measures were progression-free survival and post-operative complications; secondary outcomes were overall survival, and quality of life. Survival analyses were performed on an intention-to-treat population. Results 171 patients were randomly assigned to primary Debulking surgery (n=84) versus neoadjuvant chemotherapy (n=87). Rates of complete resection (R0) were different between the arms (47.6% in arm A vs 77.0% in arm B; p=0.001). 53 major postoperative complications were registered, mainly distributed in arm A compared with arm B (25.9% vs 7.6%; p=0.0001). All patients were included in the intent-to-treat analysis. With an overall median follow-up of 59 months (95% CI 53 to 64), 142 (83.0%) disease progressions/recurrences and 103 deaths (60.2%) occurred. Median progression-free and overall survival were 15 and 41 months for patients assigned to primary Debulking surgery, compared with 14 and 43 months for patients assigned to neoadjuvant chemotherapy, respectively (HR 1.05, 95% CI 0.77 to 1.44, p=0.73; HR 1.12, 95% CI 0.76 to 1.65, p=0.56). Conclusions Neoadjuvant chemotherapy and primary Debulking surgery have the same efficacy when used at their maximal possibilities, but the toxicity profile is different.
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timing and pattern of recurrence in ovarian cancer patients with high tumor dissemination treated with primary Debulking surgery versus neoadjuvant chemotherapy
Annals of Surgical Oncology, 2013Co-Authors: Marco Petrillo, Gabriella Ferrandina, Anna Fagotti, Giuseppe Vizzielli, P A Margariti, Anchora L Pedone, Camilla Nero, Francesco Fanfani, Giovanni ScambiaAbstract:Purpose To compare the timing and pattern of recurrence in patients with advanced ovarian cancer (AOC) receiving primary Debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval Debulking surgery (IDS).
