title: Timing and pattern of recurrence in ovarian cancer patients with high tumor dissemination treated with primary debulking surgery versus neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To compare the timing and pattern of recurrence in patients with advanced ovarian cancer (AOC) receiving primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).
  
  
  METHODS
  We retrospectively evaluated a consecutive series of 175 stage IIIC-IV epithelial ovarian cancer patients, with diffuse peritoneal carcinomatosis documented at initial surgical exploration. Forty patients received complete PDS, and the remaining 135 were treated with NACT followed by IDS with absent residual tumor after surgery.
  
  
  RESULTS
  No differences were observed in the distribution of clinical pathological characteristics at the time of diagnosis between the two groups. The median follow-up was 31 months (range 9-150 months). We observed 20 (50.0%) recurrences in the PDS group compared to 103 (76.3%) in the IDS group (p = 0.001). Duration of primary platinum-free interval (PFI) was shorter in IDS compared to PDS group (13 vs. 21 months, respectively; p = 0.014). A significantly higher percentage of patients in the IDS group experienced platinum-resistant recurrences (35.9 vs. 5.0%; p = 0.006) and carcinomatosis at the time of relapse (57.3 vs. 20.0%; p = 0.0021). Finally, in women with platinum-sensitive recurrence, we observed a shorter secondary PFI in the IDS compared to PDS group (p = 0.006).
  
  
  CONCLUSIONS
  We documented a better behavior of recurrent disease in AOC patients with diffuse peritoneal carcinomatosis treated with complete PDS compared to women submitted to NACT followed by IDS with no residual tumor after surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Petrillo
authors.forename: G
authors.initials: G
authors.lastname: Ferrandina
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
authors.forename: G
authors.initials: G
authors.lastname: Vizzielli
authors.forename: P A
authors.initials: PA
authors.lastname: Margariti
authors.forename: Anchora L
authors.initials: AL
authors.lastname: Pedone
authors.forename: C
authors.initials: C
authors.lastname: Nero
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000556:secondary / Q000628:therapy*; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000628:therapy*; D010052:Ovariectomy / Q000009:adverse effects*; D017239:Paclitaxel / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin; D016190:Carboplatin; D017239:Paclitaxel