Outcome of Epithelial Ovarian Cancer: Time for Strategy Trials to Resolve the Problem of Optimal Timing of Surgery.
BACKGROUND
The standard treatment of ovarian cancer is the combination of debulking surgery and chemotherapy. There is an ongoing discussion on which treatment is best: primary debulking surgery (PDS) or neoadjuvant chemotherapy with interval debulking (NACT-IDS). Even a large randomized trial has not settled this issue. We examined whether comparing a specified treatment protocol would not be a more logical approach to answer this type of discussions.


METHODS
A retrospective study of 142 consecutively treated patients according to a fixed protocol between 2000 and 2012 was conducted. Disease-free survival and overall survival were calculated by univariate and multivariate analyses for the whole group and for advanced stages separately. Specific differences between PDS and NACT-IDS were studied. Comparison of results from large databases was made.


RESULTS
Disease-free survival and overall 5-year survival for the whole group were 35% and 50%. For the advanced stages, disease-free survival and overall 5-year survival were 14% and 36%, with a median disease-free and overall survival of 16 and 44 months. Of the 98 women with advanced ovarian carcinoma, 54% of operable patients underwent PDS and 44% underwent NACT-IDS. More patients in the PDS group were optimally (<1 cm) debulked: 80% vs 71%. There was no significant difference in survival between PDS or NACT-IDS. Optimally debulked patients had a significant better overall survival in multivariate analysis with a hazard ratio of 2.1.


CONCLUSIONS
Outcome of treatment according to a fixed protocol with a mixture of PDS and NACT-IDS was similar to results from large databases. We hypothesize that comparison of a specific strategy may yield more useful results than awaiting the perfect randomized trial.
*Department of Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium; †Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Universiteit Hasselt, Diepenbeek, Belgium; and Departments of ‡Oncology and §Pathology, Ziekenhuis Oost Limburg, Genk, Belgium.
Gregg
G
Van de Putte
Jolien
J
Oben
Leen
L
Prenen
Jean Christophe
JC
Schobbens
Jos
J
Vlasselaer
Caroline
C
Van Holsbeke
Guy
G
Debrock
Peter
P
Van Eycken
Eric
E
de Jonge
D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*