title: The impacts of neoadjuvant chemotherapy and of debulking surgery on survival from advanced ovarian cancer.
abstract: OBJECTIVE
  Women with advanced ovarian cancer are treated with chemotherapy either before (neoadjuvant) or after surgery (primary debulking). The goal is to leave no residual disease post-surgery; for women treated with primary debulking surgery this has been associated with an improvement in survival. It has not been shown that the survival advantage conferred by having no residual disease post-surgery is present for women who receive neoadjuvant chemotherapy.
  
  
  METHODS
  We reviewed the records of 326 women with stage IIIc or IV serous ovarian cancer. We determined if they received neoadjuvant chemotherapy or primary debulking surgery and we measured the extent of residual disease post-surgery. We estimated seven-year survival rates for women after various treatments.
  
  
  RESULTS
  Women who had neoadjuvant chemotherapy were more likely to have no residual disease than women who had primary debulking surgery (50.1% versus 41.5%; p=0.03) but they experienced inferior seven-year survival (8.6% versus 41%; p<0.0001). Among women who had primary debulking surgery, those with no residual disease had much better seven-year survival than women who had any residual disease (73.6% versus 21.0%; p<0.0001). Women who had no residual disease after debulking surgery and who received intraperitoneal chemotherapy had a seven-year survival of 90%.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy should be reserved for ovarian cancer patients who are not candidates for primary debulking surgery. Among women with no residual disease after primary debulking surgery, intraperitoneal chemotherapy extends survival.
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Stephane
authors.initials: S
authors.lastname: Laframboise
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ferguson
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Dodge
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bernardini
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada; Women's College Research Institute, Women's College Hospital, Familial Breast Cancer Research Unit, 790 Bay Street, Toronto, Ontario, M5G 1N8 Canada.
authors.forename: Yakir
authors.initials: Y
authors.lastname: Segev
authors.affiliation: Women's College Research Institute, Women's College Hospital, Familial Breast Cancer Research Unit, 790 Bay Street, Toronto, Ontario, M5G 1N8 Canada.
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.affiliation: Women's College Research Institute, Women's College Hospital, Familial Breast Cancer Research Unit, 790 Bay Street, Toronto, Ontario, M5G 1N8 Canada. Electronic address: steven.narod@wchospital.ca.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D015996:Survival Rate
keywords: Intraperitoneal chemotherapy; Neoadjuvant chemotherapy; Ovarian cancer