Κατεύθυνση Χειρουργική ΟγκολογίαLibrary of the School of Health Sciences
Τούτουζας Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Φραγκουλίδης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξάκης Νικόλαος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νέο-επικουρική χημειοθεραπεία έναντι πρωτογενούς κυτταρομειωτικής χειρουργικής στην αντιμετώπιση του καρκίνου των ωοθηκών. Βιβλιογραφική ανασκόπηση και ανάλυση.
Neo-adjuvant chemotherapy vs. primary debulking surgery as treatment options for ovarian cancer. Literature review and analysis
Background / Aim: Ovarian cancer is the fourth most common gynecological cancer and is the third leading cause of death in women with gynecological malignancies. Primary debulking surgery (PDS), followed by chemotherapy, has been the most usual practice for managing advanced ovarian cancer. Neoadjuvant chemotherapy (NAC), defined as the administration of chemotherapy regimens followed by interval debulking surgery (IDS), is considered an alternative to PDS, particularly in women with extensive disease and lower performance status. The aim of this study is to review the literature and to analyze published survival studies regarding the superiority or not of any of the two methods in terms of overall and progression-free survival of patients with advanced ovarian cancer.
Material and methods: A search for studies in English language in PubMed database without a time limit was performed according to PRISMA guidelines. Specific eligibility criteria were set, leading to the inclusion of multivariate survival studies with published Hazard Ratios (HRs) comparing PDS vs. NAC-IDS. Meta-analysis methods were used, depending on the between-study heterogeneity.
Results: Of the 1879 studies that were initially chosen, 21 met the eligibility criteria. Two of them were randomized clinical trials and 19 studies were retrospective ones. The mean follow-up was 8.7 years, while the unweighted mean age of participants was 60.21 and 62.52 years in the PDS and NAC-IDS groups, respectively. The mean frequencies of complete and optimal cytoreduction were 29.14% and 60.84% in the PDS group and 49.62% and 76.96% in the NAC-IDS group, respectively. The mean median overall and progression-free survival was 43.5 and 16.3 months for PDS patients and 34.3 and 15.5 months for those in the NAC-IDS group respectively, without adjusting for sample size. The meta-analysis of 19 studies for overall survival (2 studies had insufficient data), led to a a non-statistically significant HR for NAC-IDS compared to PDS: 1.08 (95% C.I.: 0.92-1.28), p = 0.347. Regarding the progression-free survival, the meta-analysis of 8 studies (13 studies had insufficient data) produced a non-statistically significant pooled HR for NAC-IDS compared to PDS: 1.12 (95 % C.I.: 0.92-1.36), p = 0.272.
Conclusion: According to the results of our meta-analysis, there was no significant difference in overall and progression -free survival of patients with advanced ovarian cancer between NAC-IDS and PDS. This result is compatible with data from other reviews on the same subject, although they clearly had less studies meta-analyzed. With respect to the limitations of this study it seems that the NAC-IDS (as a newer method) was not inferior to the PDS.
Main subject category:
Cancer, Ovaries, Chemotherapy, Surgery, Review
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