title: The prognostic significance of optimal debulking in the setting of a complete clinical response for advanced ovarian carcinoma patients receiving maintenance chemotherapy.
abstract: OBJECTIVE
  We investigated if optimal surgical debulking increases tumor responsiveness to maintenance chemotherapy and improves survival in advanced ovarian cancer patients who previously attained a clinical complete response (CCR) to primary chemotherapy.
  
  
  METHODS
  We retrospectively reviewed 75 advanced ovarian cancer patients, of whom 43 and 32 underwent optimal versus suboptimal cytoreduction, respectively. All patients exhibited a CCR following 6 cycles of paclitaxel and carboplatin and subsequently received maintenance chemotherapy (paclitaxel 135 mg/m(2); q21 days).
  
  
  RESULTS
  The median progression free survival (PFS) for the optimally debulked patients was 35 months, compared to 20 months for the suboptimal population (P = 0.003). Moreover, a Cox model analysis revealed that an increased number of maintenance chemotherapy cycles and optimal surgical reduction significantly correlated with favorable patient PFS (P < 0.001). In regard to overall survival (OS), the patients who had optimal cytoreductive surgery exhibited improved OS results compared to the sub-optimal surgery group (42 vs. 27 months; P < 0.001). However, a Cox model analysis indicated that a greater number of maintenance chemotherapy cycles was a surrogate marker for improved OS (P < 0.001), but surgery type was not (P > 0.05). Duration of overall patient follow-up exceeds 41 months.
  
  
  CONCLUSIONS
  In advanced ovarian cancer patients who achieve a CCR following induction chemotherapy, optimal cytoreduction may confer a greater clinical benefit from a maintenance approach compared to suboptimal cytoreduction.
authors.affiliation: Gynecologic Oncology Associates, Hoag Cancer Center, 351 Hospital Road, Suite #507, Newport Beach, CA 92663, USA.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Abaid
authors.forename: Bram H
authors.initials: BH
authors.lastname: Goldstein
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Lopez
authors.forename: John P
authors.initials: JP
authors.lastname: Micha
authors.forename: John V
authors.initials: JV
authors.lastname: Brown
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rettenmaier
authors.forename: Maurie
authors.initials: M
authors.lastname: Markman
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000601:surgery*; D017239:Paclitaxel / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D016190:Carboplatin; D017239:Paclitaxel