title: Surgical treatment pattern and outcomes in epithelial ovarian cancer patients from a cancer institute in Kerala, India.
abstract: OBJECTIVE
  To evaluate the treatment and survival pattern of patients with advanced epithelial ovarian cancer.
  
  
  RESULTS
  Retrospective study of all advanced epithelial ovarian cancer patients treated in the department of gynaecologic oncology from an academic centre, in a four year period from 1 January 2008-31 December 2011.
  
  
  METHODS
  All patients with advanced epithelial ovarian cancer (stage III and IV) who underwent surgery from 2008-2011and had a follow-up of at least three months after completion of treatment were included. The decision on whether primary surgery or neoadjuvant chemotherapy (NACT) in advanced ovarian cancer was based on age, performance status, clinical and imaging findings.
  
  
  RESULTS
  A total of 178 cases of epithelial ovarian cancer were operated on during this four year period. Among them 28 patients were recurrent cases, 22 had early stages of ovarian cancer, and the rest 128 had stage III and IV ovarian cancer. In these 128 patients, 50(39.1%) underwent primary surgery and 78(60.9%) had NACT followed by surgery. In the primary surgery group 36(72.0%) patients had optimal debulking while in the NACT group 59(75.6%) patient had optimal debulking. With a median follow-up of 34 months, the median overall survival (OS) and progression free survival (PFS) was 53 and 49 months respectively. Patients who underwent primary surgery had better median PFS than patients who had NACT (56 months versus 39 months, p = 0.002). In stage III C the difference median PFS was significant for those treated with primary surgery when compared with NACT (55 months versus 39 months, p = 0.012). In patients who had optimal debulking to no residual disease (n = 90), primary surgery gave a significant improved PFS (59 months versus 38 months, p = 0.001) when compared with NACT. In univariate analysis, NACT was associated with increased risk of death (HR: 0.350; CI: 0.177-0.693).
  
  
  CONCLUSIONS
  In advanced epithelial ovarian cancer, primary surgery seems to have a definite survival advantage over NACT in patients who can be optimally debulked to no residual disease.
authors.affiliation: Public Health Research Department, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: P
authors.initials: P
authors.lastname: Georgeena
authors.affiliation: Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: Anupama
authors.initials: A
authors.lastname: Rajanbabu
authors.affiliation: Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: D K
authors.initials: DK
authors.lastname: Vijaykumar
authors.affiliation: Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: K
authors.initials: K
authors.lastname: Pavithran
authors.affiliation: Department of Biostatistics, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: K R
authors.initials: KR
authors.lastname: Sundaram
authors.affiliation: Department of Biostatistics, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: K S
authors.initials: KS
authors.lastname: Deepak
authors.affiliation: Clinical Research Department, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
authors.forename: M R
authors.initials: MR
authors.lastname: Sanal
keywords: NACT; advanced epithelial ovarian cancer; primary surgery; recurrence-free survival