title: Interval debulking surgery for advanced epithelial ovarian cancer.
abstract: BACKGROUND
  Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option.
  
  
  OBJECTIVE
  To assess the effectiveness and complications of IDS for women with advanced stage epithelial ovarian cancer.
  
  
  METHODS
  We searched the Cochrane Gynaecological Cancer Group's Specialised Register to June 2012, the Cochrane Central Register of Controlled Trials (CENTRAL) 2012, Issue 6, MEDLINE to June 2012 and EMBASE to June 2012.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing survival of women with advanced epithelial ovarian cancer, who had IDS performed between cycles of chemotherapy after primary surgery with survival of women who had conventional treatment (primary debulking surgery and adjuvant chemotherapy).
  
  
  METHODS
  Two review authors independently assessed trial quality and extracted data. Searches for additional information from study authors were attempted. We performed meta-analysis of overall and progression-free survival (PFS), using random-effects models.
  
  
  RESULTS
  Three RCTs randomising 853 women, of whom 781 were evaluated, met the inclusion criteria. Meta-analysis of three trials for overall survival (OS) found no statistically significant difference between IDS and chemotherapy alone (hazard ratio (HR) = 0.80, 95% confidence interval (CI) 0.61 to 1.06, I² = 58%). Subgroup analysis for OS in two trials, where the primary surgery was not performed by gynaecologic oncologists or was less extensive, showed a benefit of IDS (HR = 0.68, 95% CI 0.53 to 0.87, I² = 0%). Meta-analysis of two trials for PFS found no statistically significant difference between IDS and chemotherapy alone (HR = 0.88, 95% CI 0.57 to 1.33, I² = 83%). Rates of toxic reactions to chemotherapy were similar in both arms (risk ratio = 1.19, 95% CI 0.53 to 2.66, I² = 0%), but little information was available for other adverse events or quality or life (QoL).
  
  
  CONCLUSIONS
  We found no conclusive evidence to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in women whose primary surgery was not performed by gynaecologic oncologists or was less extensive. Data on QoL and adverse events were inconclusive.
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand. siriwanonco@yahoo.com.
authors: Siriwan
authors: S
authors: Tangjitgamol
authors: Sumonmal
authors: S
authors: Manusirivithaya
authors: Malinee
authors: M
authors: Laopaiboon
authors: Pisake
authors: P
authors: Lumbiganon
authors: Andrew
authors: A
authors: Bryant
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods / Q000401:mortality; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction / Q000379:methods; D047368:Tumor Burden / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents
references: N Engl J Med. 1995 Mar 9;332(10):629-34
references: 7845426
references: Int J Gynecol Cancer. 2006 Jan-Feb;16 Suppl 1:60-7
references: 16515569
references: Cochrane Database Syst Rev. 2011 Aug 10;(8):CD007565
references: 21833960
references: Int J Clin Oncol. 2004 Apr;9(2):113-9
references: 15108043
references: Gynecol Oncol. 2003 Jan;88(1):9-16
references: 12504620
references: Int J Cancer. 2010 Dec 15;127(12):2893-917
references: 21351269
references: Curr Oncol Rep. 2003 Nov;5(6):473-81
references: 14521806
references: Gynecol Oncol. 1991 Aug;42(2):146-50
references: 1894174
references: J Clin Oncol. 2005 Aug 20;23(24):5605-12
references: 16110020
references: Gynecol Oncol. 2009 Apr;113(1):57-62
references: 19181369
references: Cancer Chemother Pharmacol. 2005 Oct;56(4):427-35
references: 15906030
references: Vopr Onkol. 1982;28(7):28-34
references: 7101824
references: Eur J Gynaecol Oncol. 2006;27(1):25-8
references: 16550963
references: Control Clin Trials. 1986 Sep;7(3):177-88
references: 3802833
references: J Am Coll Surg. 2003 Dec;197(6):955-63
references: 14644284
references: J Obstet Gynaecol Res. 2006 Feb;32(1):99-106
references: 16445534
references: Chin Med J (Engl). 2004 Oct;117(10):1547-51
references: 15498381
references: Am J Obstet Gynecol. 1994 Apr;170(4):974-9; discussion 979-80
references: 8166218
references: Gynecol Oncol. 1999 Jan;72(1):93-9
references: 9889037
references: J Clin Oncol. 2002 Mar 1;20(5):1248-59
references: 11870167
references: N Engl J Med. 2010 Sep 2;363(10):943-53
references: 20818904
references: Gynecol Oncol. 2007 Feb;104(2):480-90
references: 17166564
references: Gynecol Oncol. 1998 Dec;71(3):431-6
references: 9887245
references: Aust N Z J Obstet Gynaecol. 1988 May;28(2):121-6
references: 3067699
references: Br J Obstet Gynaecol. 1994 Feb;101(2):142-6
references: 8305389
references: N Engl J Med. 2004 Dec 9;351(24):2489-97
references: 15590951
references: Gynecol Oncol. 2009 Mar;112(3):444-9
references: 19138791
references: Gynecol Oncol. 2009 Feb;112(2):394-9
references: 19058838
references: Cancer. 2001 Nov 15;92(10):2585-91
references: 11745193
references: Int J Gynecol Cancer. 2005 Mar-Apr;15(2):217-23
references: 15823102
references: Int J Gynecol Cancer. 2003 Sep-Oct;13(5):587-92
references: 14675340
references: J Clin Epidemiol. 1997 Jun;50(6):683-91
references: 9250266
references: Natl Cancer Inst Monogr. 1975 Oct;42:101-4
references: 1234624
references: Obstet Gynecol. 1989 Jan;73(1):61-5
references: 2462202
references: Gynecol Oncol. 2006 Mar;100(3):455-61
references: 16325244
references: Cancer. 2001 Jun 15;91(12):2329-34
references: 11413522
references: Gynecol Oncol. 2006 Dec;103(3):1070-6
references: 16875720
references: Oncol Rep. 2009 Sep;22(3):605-13
references: 19639211
references: N Engl J Med. 1995 Jul 27;333(4):254-5; author reply 255
references: 7791844
references: Int J Gynecol Cancer. 2001 Nov-Dec;11(6):466-70
references: 11906550
references: Stat Med. 1998 Dec 30;17(24):2815-34
references: 9921604
references: Eur J Gynaecol Oncol. 2001;22(4):287-91
references: 11695811
references: Oncology. 2003;65(4):316-22
references: 14707451
references: Cochrane Database Syst Rev. 2012 Aug 15;(8):CD005343
references: 22895947
references: Gynecol Oncol. 2003 Jul;90(1):163-9
references: 12821358
references: BMJ. 2003 Sep 6;327(7414):557-60
references: 12958120