Neoadjuvant Chemotherapy in the Comprehensive Treatment of Patients with Stage III–IV Ovarian Cancer
- 1Ivano-Frankivsk National Medical University, Ukraine
- 2Municipal Nonprofit Enterprise «Prykarpattia Clinical Oncology Center of Ivano-Frankivsk Regional Council», Ukraine
Summary. Objective. To evaluate the effectiveness of neoadjuvant chemotherapy followed by an interval cytoreductive surgery compared to primary cytoreductive surgery with subsequent chemotherapy cycles. Materials and methods. The analysis involved treatment results of 142 patients with stage III–IV ovarian cancer, who received treatment at the Municipal Nonprofit Enterprise «Prykarpattia Clinical Oncology Center of Ivano-Frankivsk Regional Council» from 2017 to 2023. The patients were divided into two groups based on the treatment method: group I (69 patients) — primary debulking surgery (PDS) followed by adjuvant cycles of polychemotherapy; group II (73 patients) — 3 neoadjuvant cycles of polychemotherapy, followed by interval debulking surgery (IDS), and adjuvant cycles of polychemotherapy. All patients received chemotherapy according to the paclitaxel-carboplatin regimen. The effectiveness of IDS was compared to PDS by analyzing the peritoneal cancer index (PCI), dynamics of tumor marker CA-125 reduction, tumor pathomorphosis, surgical complications, treatment outcomes, quality of life, and long-term results. Results. The results showed that after neoadjuvant chemotherapy (NACT), the PCI decreased by 1.4 times to an average of 12.9±4.6 points. The duration of surgery was 1.3 times longer in group I (PDS) compared to group II (IDS), and there was also a 1.3-fold increase in intraoperative blood loss in group I. The analysis of tumor pathomorphosis and the radicality of cytoreductive surgeries in group II revealed that with pathomorphosis grades III–IV, no non-radical cytoreductive surgeries were performed, with optimal cytoreductions being predominant. A statistically significant correlation was found between CA-125 reduction and pathomorphosis grades 0, I, II, and III (p <0.05), but not with pathomorphosis grade IV (p >0.05). According to the obtained results, overall cumulative survival in groups I and II did not significantly differ: 3-year overall cumulative survival was 50% in group I and 58% in group II. However, 3-year recurrence-free cumulative survival was 24% in group I and 48% in group II. The median recurrence-free survival in group I was 19 months, while in group II it was 25 months. Conclusions. The use of neoadjuvant chemotherapy in patients with stage III–IV ovarian cancer reduces the peritoneal cancer index, surgery duration, intraoperative complications, and helps identify platinum-resistant tumors. Three-year overall cumulative survival was similar in patients who initially underwent surgery or neoadjuvant chemotherapy, but recurrence-free survival was significantly higher in patients who received neoadjuvant chemotherapy cycles.
Leave a comment