title: Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery and the Risk of Platinum Resistance in Epithelial Ovarian Cancer.
abstract: BACKGROUND
  Interval debulking surgery (IDS) is an option for treating patients with advanced ovarian carcinoma. Two randomized trials have shown similar survival rates for primary debulking surgery (PDS) and IDS. One of the concerns with IDS is the potentially higher risk of inducing platinum resistance when treating patients with greater disease volume.
  
  
  METHODS
  A retrospective review of data on 237 patients with stage IIIC and IV ovarian carcinoma who were treated at a single institution from 2000 to 2013. We analyzed the association of IDS with time to first platinum resistant relapse (TTPR); platinum-resistant disease at first relapse, defined as a platinum-free interval (PFI) after first-line chemotherapy of <6 months; and overall response rate (ORR) to chemotherapy at first platinum-sensitive relapse.
  
  
  RESULTS
  The TTPR was 60 months, and the median TTPR was longer for the PDS (80.8 months) versus IDS group (39.3 months; p = 0.012) and for patients with residual disease (RD) ≤10 mm (80.8 months) compared with those with RD >10 mm (26.1 months; p < 0.001). In the multivariate analysis, IDS [hazard ratio (HR) 1.92; p = 0.009] and RD >10 mm (HR 1.65; p < 0.001) retained an increased risk of developing platinum-resistant disease. IDS was not associated with a greater risk of PFI <6 months at first relapse, and the ORR to platinum-based chemotherapy at first platinum-sensitive relapse was 87.2 % for patients who were treated with PDS compared with 68.0 % for those who underwent IDS (p = 0.051).
  
  
  CONCLUSIONS
  IDS correlates with a higher risk of the development of platinum resistance.
authors.affiliation: Medical Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil. alebalieiro@uol.com.br.
authors.forename: Alexandre A B A
authors.initials: AA
authors.lastname: da Costa
authors.affiliation: Medical Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Camila V
authors.initials: CV
authors.lastname: Valadares
authors.affiliation: Gynecology Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Glauco
authors.initials: G
authors.lastname: Baiocchi
authors.affiliation: Gynecology Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Mantoan
authors.affiliation: Medical Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Saito
authors.affiliation: Medical Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Solange
authors.initials: S
authors.lastname: Sanches
authors.affiliation: Medical Oncology Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Andréia P
authors.initials: AP
authors.lastname: Guimarães
authors.affiliation: Oncogenetics Department, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Maria Isabel W
authors.initials: MI
authors.lastname: Achatz
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000628:therapy; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000628:therapy; D065426:Cytoreduction Surgical Procedures; D019008:Drug Resistance, Neoplasm; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000628:therapy; D010984:Platinum / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D010984:Platinum