title: Optimal timing of interval debulking surgery in advanced ovarian cancer: yet to be defined?
abstract: OBJECTIVE
  Interval debulking surgery (IDS) following neo-adjuvant chemotherapy (NAC) is a treatment option in advanced ovarian cancer. It is recommended to perform IDS early, after 3 cycles of NAC, but late IDS (after 6 cycles) may yield better results. Delaying IDS, however, harbours the risk of loosing the opportunity for debulking surgery.
  
  
  METHODS
  Retrospective comparison of two groups of patients with advanced ovarian carcinoma (stages IIC-IV) treated by platinum-based chemotherapy (CT) having undergone early IDS (after 3.6 cycles, group 1, n=33) or late IDS (after 6.3 cycles, group 2, n=104). Contemporary patients who had undergone standard treatment by primary debulking surgery (PDS)+CT (group 3, n=446) and those treated by CT alone (group 4, n=64 patients) served as internal controls.
  
  
  RESULTS
  Prognosis in IDS patients (groups 1+2) was comparable to that in PDS patients (group 3). Only a few patients in group 4 potentially had lost an opportunity for debulking surgery. Groups 1 and 2 were well-matched concerning usual prognostic factors. Surgery extent and post-operative outcomes were similar in both. In contrast, complete cytoreductions were significantly more frequent in late than in early IDS (group 2 vs.1: 58% vs. 36%, p=0.03) and survival was not inferior in the late IDS group compared to the early IDS group with 37 vs. 22 months, respectively (p=0.09).
  
  
  CONCLUSIONS
  Late IDS yields higher complete resection rates than early IDS and should be evaluated prospectively for outcome in further trials.
authors.affiliation: Department of Surgery, Institut Bergonié, Regional Cancer Centre, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France. stoeckle@bergonie.org
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stoeckle
authors.forename: Benjamin
authors.initials: B
authors.lastname: Boubli
authors.forename: Anne
authors.initials: A
authors.lastname: Floquet
authors.forename: Véronique
authors.initials: V
authors.lastname: Brouste
authors.forename: Marie
authors.initials: M
authors.lastname: Sire
authors.forename: Sabrina
authors.initials: S
authors.lastname: Croce
authors.forename: Laurence
authors.initials: L
authors.lastname: Thomas
authors.forename: Frédéric
authors.initials: F
authors.lastname: Guyon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents