The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .
A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer.
OBJECTIVE To assess the ability of preoperative computed tomography ( CT ) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal ( > 1 cm residual disease ) primary cytoreduction in advanced ovarian , fallopian tube , and peritoneal cancer . METHODS This was a prospect i ve , non-r and omized , multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian , fallopian tube , and peritoneal cancer . A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery , respectively . Four clinical and 20 radiologic criteria were assessed . RESULTS From 7/2001 to 12/2012 , 669 patients were enrolled ; 350 met eligibility criteria . The optimal debulking rate was 75 % . On multivariate analysis , three clinical and six radiologic criteria were significantly associated with suboptimal debulking : age ≥ 60 years ( p=0.01 ) ; CA-125 ≥ 500 U/mL ( p<0.001 ) ; ASA 3 - 4 ( p<0.001 ) ; suprarenal retroperitoneal lymph nodes > 1 cm ( p<0.001 ) ; diffuse small bowel adhesions/thickening ( p<0.001 ) ; and lesions > 1 cm in the small bowel mesentery ( p=0.03 ) , root of the superior mesenteric artery ( p=0.003 ) , perisplenic area ( p<0.001 ) , and lesser sac ( p<0.001 ) . A ' predictive value score ' was assigned for each criterion , and the suboptimal debulking rates of patients who had a total score of 0 , 1 - 2 , 3 - 4 , 5 - 6 , 7 - 8 , and ≥ 9 were 5 % , 10 % , 17 % , 34 % , 52 % , and 74 % , respectively . A prognostic model combining these nine factors had a predictive accuracy of 0.758 . CONCLUSIONS We identified nine criteria associated with suboptimal cytoreduction , and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score . These results may be helpful in pretreatment patient assessment
The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .