Effect of time interval from completion of neoadjuvant chemotherapy to starting of adjuvant chemotherapy after interval debulking surgery on survival of patients with advanced ovarian cancer
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20231217Keywords:
Neoadjuvant therapy, Interval de bulking surgery, Postoperative adjuvant therapy, Overall survival, Recurrence free survival, Time interval, Time to chemotherapy, Time to surgeryAbstract
Background: To find the effect of time interval between completion of neo adjuvant chemotherapy to the starting of adjuvant chemotherapy on the RFS and OS of patients with advanced ovarian cancers.
Methods: It is a retrospective study of 170 patients with histopathological proven epithelial ovarian cancers who received full treatment (NACT+IDS+POAC) at Gujarat cancer Research Institute, Ahmedabad between 2010- 2016. They were assessed and followed up for maximum 5 year. The time interval was defined as period from the completion of NACT including Interval de-bulking surgery to initiation of chemotherapy.
Results: Out of 170 patients, 86 patients (50.5%) received adjuvant chemotherapy within 44 days after neoadjuvant chemotherapy while 84 patients (49.4%) received it after 44 days. There was no significant difference in patient characteristics between these two groups. The shorter and longer TI was having recurrence in 40 (53.48%) and47 (55.55%) patients respectively. Whereas overall survival was 67.44% and 47.61% respectively.
Conclusions: Our analysis showed that patients with longer time interval >44 days had poorer recurrence free survival and overall survival in comparison to lesser TI group.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
NIH. Cancer Stat Facts, 2017. Available at: https://seer.cancer.gov/statfacts/. Accessed on 20 March 2023.
Morgan RJ, Alvarez RD, Armstrong DK, Burger RA, Castells M, Chen CH, et al. Ovarian cancer, version 3.2012. J Natl Compr Cancer Netw. 2012;10:1339-49.
Vergote I, du Bois A, Amant F, Heitz F, Leunen K, Harter P. Neoadjuvant chemotherapy in advanced ovarian cancer: on what do we agree and disagree? Gynecol Oncol. 2013;128(1):6-11.
Nishio S, Ushijima K. Clinical significance of primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery in advanced ovarian cancer. Jpn J Clin Oncol. 2020;50(4):379-86.
Lv X, Cui S, Zhang X, Ren C. Efficacy and safety of neoadjuvant chemotherapy versus primary debulking surgery in patients with ovarian cancer: a meta-analysis. J Gynecol Oncol. 2020;31(2):e12.
Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cance. N Engl J Med. 2010;363:943-5.
National comprehensive cancer network group. NCCN Clinical Practice Guidelines in Oncology. Ovarian Cancer (Version 1.2018). Available at: NCCN.org. http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Accessed on 28th February 2018.
Timmermans M, van der Aa MA, Lalisang RI, Witteveen PO, Van de Vijver KK, Kruitwagen RF, et al. Interval between debulking surgery and adjuvant chemotherapy is associated with overall survival in patients with advanced ovarian cancer. Gynecol Oncol. 2018;150(3):446-50.
Tewari KS, Java JJ, Eskander RN, Monk BJ, Burger RA. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study. Annals of Oncology. 2016;27(1):114-21.
Seagle BLL, Butler SK, Strohl AE, Nieves-Neira W, Shahabi S. Chemotherapy delay after primary debulking surgery for ovarian cancer. Gynecol Oncol. 2017;144:260265.
Gagliato DdM, Gonzalez-Angulo AM, Lei X. Clinical impact of delaying initiation ofadjuvant chemotherapy in patients with breast cancer. J Clin Oncol. 2014;32:735-44.
Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation ofadjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2:322-9.
Des Guetz G, Nicolas P, Perret GY, Morere JF, Uzzan B. Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer. 2010;1049-55.
Czaykowski PM, Gill S, Kennecke HF, Gordon VL, Turner D. Adjuvant chemotherapy for stage III colon cancer: does timing matter? Dis Colon Rectum. 2011;54:1082-9.
Feng Z, Wen H, Bi R. Prognostic impact of the time interval from primary surgery to intravenous chemotherapy in high grade serous ovarian cancer. Gynecol Oncol. 2016;141:466-70.
National comprehensive cancer network group. NCCN Clinical Practice Guidelines in Oncology. Myeloid growth factors (Version 1.2018). Available at: https://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.p df. Accessed on 2nd March 2018.
National comprehensive cancer network group. NCCN Clinical Practice Guidelines in Oncology. Cancer- and chemotherapy-induced anemia (Version 2.2018). Available at: https://www.nccn.org/professionals/physician_gls/pdf/anemia. pdf. Accessed on 21st November 2017.
Lee YJ, Chung YS, Lee JY, Nam EJ, Kim SW, Kim S, et al. Impact of the time interval from completion of neoadjuvant chemotherapy to initiation of postoperative adjuvant chemotherapy on the survival of patients with advanced ovarian cancer. Gynecol Oncol. 2018;148:62-7.
Wright JD, Herzog TJ, Neugut AI, Burke WM, Lu YS, Lewin SN, et al. Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advance-stage ovarian cancer. Obstet Gynecol. 2012;120:871-81.
Hofstetter G, Concin N, Braicu I, Chekerov R, Sehouli I, Van Gorp CT, et al. The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma-analysis of patient data in the prospective OVCAD study. Gynecologic oncology. 2013;131(1):15-20.
Gunduz N, Fisher B, Saffer EA. Effect of surgical removal on the growth and kinetic so residual tumor. Cancer Res. 1979;39:3861-5.
Eggermont AM, Steller EP, Sugarbaker PH. Laparotomy enhances intraperitoneal tumor growth and abrogates the antitumor effects of interleukin-2 and lymphokine-activated killer cells. Surgery. 1987;102:71-8.
Chiang YC, Chen CA, Chiang CJ, Hsu TH, Lin MC, You SL, et al. Trends in incidence and survival out- come of epithelial ovarian cancer: 30-year national population-based registry in Taiwan. J GynecolOncol. 2013;24:342-51.
Pelissier A, Bonneau C, Chéreau E, de La Motte Rouge T, Fourchotte V, Daraï E, et al. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2014;135(3):542-6.
