TITLE:
Neoadjuvant Chemotherapy Followed by Surgery versus Primary Surgery in Advanced Epithelial Ovarian Cancer: A Review of Outcomes at National Institute of Cancer Research Hospital in Bangladesh
AUTHORS:
Farhana Kalam, Shahana Pervin, K. M. Nazmul Islam Joy, Johirul Islam, Annekathryn Goodman
KEYWORDS:
Neoadjuvant Chemotherapy, Interval Debulking Surgery, Primary Debulking Surgery, Cytoreductive Surgery, Epithelial Ovarian Cancer, Bangladesh
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.12 No.11,
November
19,
2021
ABSTRACT: Introduction: This study evaluated the difference in operative
and clinical outcomes for
patients with advanced ovarian cancer after primary debulking surgery
(PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in Bangladesh. Methods: Sixty patients with advanced epithelial
ovarian cancer presenting to the department of Gynaecological Oncology
at the National Institute of Cancer Research and Hospital were prospectively
enrolled. Thirty patients underwent primary debulking surgery and thirty
patients received NACT followed by IDS. Results: In the PDS and IDS
groups respectively, 56.7% and 50% of patients presented with stage IIIC and
67.7% and 56.7% respectively had serious
papillary type histopathology. Duration of surgery, amount of blood loss and
total hospital stay were significantly lower (p in the PDS group. There was a statistically significant difference in
postoperative tumor residuals between IDS and PDS patients. Complete tumor
resection (R0) was obtained in 24 (80%) of IDS patients versus 13 (43.3%) PDS
patients. In fifteen months of follow-up, 21 (70%) in the PDS group and 5
(16.7%) in the IDS group recurred (p = 0.021). Median progression free survival in PDS patients was twelve months
while that of the IDS group was seventeen months. There was one death at 45
days in the PDS group. No other deaths were documented at fifteen months of
follow-up. Conclusion: Interval
debulking surgery has a more favorable outcome than primary debulking surgery
on progression free survival in advanced ovarian cancer patients and permits a less aggressive surgery to be performed in Bangladesh.