title: Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness.
abstract: OBJECTIVE
  Three cycles of neoadjuvant chemotherapy (NACT) followed by interval debulking (ID) surgery is an alternative for patients with advanced ovarian cancer unresectable disease. This study aimed to determine the efficacy and safety of six cycles of NACT followed by cytoreduction.
  
  
  METHODS
  Retrospective analysis of all patients with advanced epithelial ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma treated with platinum based NACT between January 2008 and February 2012.
  
  
  RESULTS
  Eighty-two patients underwent NACT; 78% and 18.2% had extensive stage IIIC or IV disease at diagnosis, respectively. Their median age was 60 years (41-82). On histology, serous adenocarcinoma was found in 90.2%. Patients did not receive chemotherapy after debulking surgery. 35.4% suffered grade 3/4 toxicity; the most commonly observed toxicities were hematologic and nausea. After NACT, 23.1% experienced clinical complete response, 57.4% partial response, and 12.1% disease progression. Complete resection of all macroscopic and microscopic disease (R0) was performed in 63.7%. Surgical complications were uncommon; however, four (6.2%) patients needed a second procedure due to operative complications and 18 (27.3%) needed blood transfusion after debulking. Over a median follow-up period of 19.2 months, median overall survival and chemotherapy-free interval were 37.5 months (confidence interval not reached) and 16 months, respectively.
  
  
  CONCLUSIONS
  Six cycles of neoadjuvant carboplatin and paclitaxel was safe and effective and did not increase perioperative or postoperative complications in patients with stage IIIC/IV disease who were unsuitable for optimal PDS. The overall survival of this cohort was higher than that of those treated with ID surgery.
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.. Electronic address: vamedabc@yahoo.com.br.
authors: Vanessa
authors: V
authors: da Costa Miranda
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Ângelo Bezerra
authors: ÂB
authors: de Souza Fêde
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Carlos Henrique
authors: CH
authors: Dos Anjos
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Juliana Ribeiro
authors: JR
authors: da Silva
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Fernando Barbosa
authors: FB
authors: Sanchez
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Lyvia Rodrigues
authors: LR
authors: da Silva Bessa
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Jesus
authors: J
authors: de Paula Carvalho
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Elias Abdo
authors: EA
authors: Filho
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Daniela
authors: D
authors: de Freitas
authors: Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
authors: Maria
authors: M
authors: Del Pilar Estevez Diz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D016190:Carboplatin; D017239:Paclitaxel
keywords: Carboplatin and paclitaxel; Neoadjuvant therapy; Ovarian cancer; Survival; Toxicity