Neoadjuvant chemotherapy for advanced ovarian cancer: Long-term survival

Purpose. The aim of this study was to compare the progression-free and over all survivals of women with advanced ovarian cancer treated with neoadjuvan t chemotherapy followed by surgery with those treated conventionally with c ytoreductive surgery followed by cytotoxic chemotherapy. Materials and Methods, Fifty-nine consecutive women with advanced malignanc ies compatible with ovarian cancer based on (1) physical examinations, (2) computerized tomography scans, and (3) cytologic or histologic specimens an d treated with platinum-based combination chemotherapy, i.e., neoadjuvant c hemotherapy, were retrospectively reviewed. Forty-one subsequently underwen t cytoreductive surgery. Their overall and progression-free survivals were compared to those of 206 consecutive women with Stage IIIC and IV epithelia l ovarian cancers treated with conventional cytoreductive surgery followed by platinum-based combination chemotherapy during the same era. Results. No statistical difference was observed in overall survival (P = 0. 1578) or in progression-free survival between the group treated with neoadj uvant chemotherapy and the conventionally treated group (P = 0.5327) despit e the neoadjuvant chemotherapy patients being statistically older (median a ge 67 years [range 44 to 85 years] vs a median age of 60 years [range 19 to 79 years] for conventionally treated patients; P < 0.001) and having a sta tistically poorer performance status (P < 0.001) than the conventionally tr eated group. Women undergoing cytoreductive surgery following neoadjuvant c hemotherapy had a statistically improved overall survival (P < 0.0001) comp ared to those who did not undergo surgery. Conclusions. Neoadjuvant chemotherapy does not compromise the survival of w omen treated for advanced ovarian cancer. Prospective randomized trials com paring neoadjuvant chemotherapy to conventional therapy to determine qualit y of life experiences and cost/benefit outcomes are now appropriate for wom en presenting with advanced ovarian cancer, (C) 1999 Academic Press.