title: Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center.
abstract: OBJECTIVE
  The aim of this study was to evaluate the use of neoadjuvant chemotherapy (NACT) and primary debulking surgery (PDS) before and after results from a randomized trial were published and showed non-inferiority between NACT and PDS in the management of advanced-stage ovarian carcinoma.
  
  
  METHODS
  We evaluated consecutive patients with advanced-stage ovarian cancer treated at our institution from 1/1/08-5/1/13, which encompassed 32 months before and 32 months after the randomized trial results were published. We included all newly diagnosed patients with high-grade histology and stage III/IV disease. Associations between the use of NACT and clinical variables over time were evaluated.
  
  
  RESULTS
  Our study included 586 patients. Median age was 62 years (range, 30-90); 406 patients (69%) had stage III disease, and 570 (97%) had disease of serous histology. Twenty-six percent (154/586) were treated with NACT and 74% (432/586) with PDS. NACT use increased significantly from 22% (56/256) before 2010 (at which point the results of the randomized trial were published) to 30% (98/330) after 2010 (p=0.037). Although patients who underwent PDS were more likely to experience grade 3/4 surgical complications than those who underwent NACT, those selected for PDS had a median OS of 71.7 months (CI, 59.8-not reached) compared with 42.9 months (CI 37.1-56.3) for those selected for NACT.
  
  
  CONCLUSIONS
  In this single-institution analysis, the best survival outcomes were observed in patients who were deemed eligible for PDS followed by platinum-based chemotherapy. Selection criteria for NACT require further definition and should take institutional surgical strategy into account.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Mueller
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Qin C
authors.initials: QC
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Alexia
authors.initials: A
authors.lastname: Iasonos
authors.affiliation: Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Roisin E
authors.initials: RE
authors.lastname: O'Cearbhaill
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Farah A
authors.initials: FA
authors.lastname: Alvi
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Amr
authors.initials: A
authors.lastname: El Haraki
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: Ane Gerda Zahl
authors.initials: AG
authors.lastname: Eriksson
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Levine
authors.affiliation: Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Carol
authors.initials: C
authors.lastname: Aghajanian
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States. Electronic address: zivanovo@mskcc.org.
authors.forename: Oliver
authors.initials: O
authors.lastname: Zivanovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D017024:Chemotherapy, Adjuvant / Q000639:trends; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000639:trends; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000639:trends; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
keywords: Advanced-stage ovarian cancer; Interval debulking surgery; Neoadjuvant chemotherapy; Overall survival; Primary debulking surgery; Progression-free survival