Outcomes of advanced epithelial ovarian cancer with integration of metronomic chemotherapy: An Indian rural cancer centre experience.
BACKGROUND
Paclitaxel-platinum and optimal cytoreductive surgery are the standard of care for ovarian carcinoma. Poor socioeconomic profile and therapeutic constraints in rural India poses a therapeutic challenge.


OBJECTIVE
To evaluate outcomes of epithelial ovarian carcinoma.


OBJECTIVE
To calculate disease-free survival (DFS), overall survival (OS), and factors affecting outcomes.


METHODS
Data of patients diagnosed as ovarian carcinoma registered between March 2009 and March 2014 were retrieved. Demographic profile, chemotherapy and response, surgery, and disease progression were collected. Patients who underwent surgery or completed three cycles of chemotherapy were selected. Kaplan-Meir survival was used to determine disease-free and OS. Log-rank test used to evaluate factors affecting outcome.


RESULTS
Median follow-up is 26 months. 93/102 patients (91%) underwent cytoreductive surgery, of which 37 had primary cytoreduction (40%) while 56 had interval cytoreduction. 21/93 (23%), 57/93 (61%), and 15/93 (16%) patients were operated by local surgeons, surgeons of our hospital, and trained oncosurgeons, respectively. Induction paclitaxel-platinum was used in 35/63 (56%) patients while 28/63 patients (44%) received neoadjuvant metronomic chemotherapy. Median DFS and OS are 17 and 54 months respectively while 3 year OS of 66%. Median DFS of patients operated by oncosurgeons versus local surgeons were 22 months versus 15 months (P = 0.01), OS was 54 versus 26 months (P = 0.01).40/88 (45%) patients received maintenance metronomic therapy after adjuvant chemotherapy with median of 6 months (range 2-18 months). Patients receiving metronomic maintenance had better DFS, 18 months versus 15 months (P = 0.69).


CONCLUSIONS
Induction therapy in ovarian carcinoma helps in selecting patients for cytoreductive surgery. Outcomes are better if operated by trained oncosurgeons. Maintenance metronomic has potential to delay disease progression.
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Department of Medical Oncology, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra, India.
Avinash
A
Pandey
Department of Surgical Oncology, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra, India.
Desai
D
Abhay
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Jandyal
J
Sunny
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Ostwal
O
Vikas
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Patil
P
Vijay
Department of Pathology, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra, India.
Kulkarni
K
Rajeshri
Department of Radiodiagnosis, BKLWH, Dervan, Chiplun, Ratnagiri, Maharashtra, India.
Patil
P
Netaji
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Gupta
G
Sudeep
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Shripad D
SD
Banavali
Advanced epithelial carcinoma ovary; metronomic maintenance; metronomic neoadjuvant