Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy: a retrospective study
| Autor: | J.-F. Geay, X. Paoletti, B. Deval, Eric Pujade-Lauraine, Arash Rafii, N. Chopin, D. Paraiso |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Disease-Free Survival law.invention Randomized controlled trial law Biopsy medicine Humans Neoadjuvant therapy Aged Neoplasm Staging Retrospective Studies Ovarian Neoplasms Chemotherapy Hysterectomy medicine.diagnostic_test business.industry Obstetrics and Gynecology Epithelial Cells Retrospective cohort study Middle Aged medicine.disease Debulking Neoadjuvant Therapy Surgery Oncology Disease Progression Female business Ovarian cancer |
| Zdroj: | International Journal of Gynecological Cancer. 17:777-783 |
| ISSN: | 1525-1438 1048-891X |
| DOI: | 10.1111/j.1525-1438.2007.00905.x |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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