Neoadjuvant chemotherapy for unresectable ovarian carcinoma - A French multicenter study

BACKGROUND. Initial debulking surgery followed by chemotherapy is the curre nt treatment for International Federation of Gynecology and Obstetrics Stag e IIIC/IV ovarian carcinoma but has a limited efficacy when optimal cytored uction is not achieved at the end of the surgical procedure. An alternative treatment for these patients could be neoadjuvant chemotherapy. The purpos e of this retrospective study was to report the results of neoadjuvant chem otherapy in operable patients (no medical contraindication to surgery) pres enting with primary unresectable tumors. METHODS. Between January 1996 and March 1999, operable patients presenting with Stage IIIC or IV ovarian carcinoma underwent, in six French gynecologi c oncology departments, surgical staging to evaluate tumor resectability. W hen the tumor was deemed unresectable by standard surgery, the patient rece ived three to six cycles of platinum-based neoadjuvant chemotherapy accordi ng to the response and the center's usual protocol. Patients were surgicall y explored after completion of neoadjuant chemotherapy when the tumor did n ot progress during treatment. Debulking was performed during this secondary surgery when a response to chemotherapy was observed. RESULTS. Fifty-four patients were treated by neoadjuvant chemotherapy. The first surgical staging procedure was laparoscopy in 33 patients (61%) and l aparotomy in 21 patients (39%). The median number of neoadjuvant chemothera py cycles was 4 (range, 0-6). Forty-three patients (80%) responded to neoad juvant chemotherapy and then tumors were debulked. Optimal cytoreduction wa s obtained in 39 patients (91% of the patients who underwent debulking) and with standard surgery in 32 patients (82%). For patients whose tumors were optimally debulked, blood transfusions were administered to 17 patients (4 3%), median intensive care unit stay was 0 days (range, 0-7 days), and medi an postoperative hospital stay was 10 days (range, 4-62 days). Median overa ll survival for the total series was 22 months. Survival was better for pat ients debulked after neoadjuvant chemotherapy compared with patients with n ondebulked tumors (P < 0.001). CONCLUSIONS, Neoadjuvant chemotherapy for primary unresectable ovarian carc inoma leads to the selection of a subset of patients sensitive to chemother apy in whom optimal cytoreduction can be achieved after chemotherapy by sta ndard surgery in a high proportion of cases. Conversely, aggressive surgery can be avoided in patients with initial chemoresistance, in whom the progn osis is known to be poor regardless of treatment. (C) 2001 American Cancer Society.