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Background: Ovarian cancer represents the sixth most commonly diagnosed cancer among women in the world and causes more deaths per year than any other cancer of the female reproductive system. Most patients with epithelial ovarian carcinoma present with advanced disease (International Federation of Gynecology and Obstetrics (FIGO) stage IIIc or IV). Primary debulking surgery (PDS) followed by chemotherapy is the standard treatment for ovarian cancer. Neoadjuvant chemotherapy followed by interval debulking surgery (IDS) could be an alternative treatment for these patients.Objective: In the current work, we compared between primary debulking surgery and neoadjuvant chemotherapy followed by interval debulking surgery with the overall and progression free survival as primary end points and surgical morbidity as a secondary end point.Methods: a prospective randomized study was conducted on 50 patients with histopathologically proven epithelial ovarian cancer with advanced stage (IIIb /IIIc). The patients were randomly assigned either to primary debulking surgery followed by chemotherapy (paclitaxel-carboplatin) (PDS group; n = 25) or to three to six courses of neoadjuvant chemotherapy (paclitaxel-carboplatin) followed by interval debulking surgery in all patients who achieved response or even stable disease (NACT group; n=20/25).Results: Optimal cytoreduction was performed in 52% in PDS group & 55% in NACT group with insignificant P value (0.84). The results of surgical parameters of cytoreduction in both groups showed no significant differences as regard the mean operative duration, the blood loss rates (number of transfused blood units),and the length of postoperative hospital stay. Moreover, there was no difference between the postoperativecomplications in both groups. The median overall survival time was not statistically different (P = 0.55) in both treatment arms (29 vs 30 months, respectively). Longer median progression free survival in the NACT group in comparison to the PDS group (22 vs 19 months, respectively) was detected, but it didn't reach statistical significance (P=0.11).Conclusions: Despite that primary cytoreductive surgery is considered the standard of care for advanced ovarian carcinoma, eoadjuvant chemotherapy is not inferior to primary cytoreductive surgery for patients with advanced stage ovarian carcinoma. |
