Debulk advanced ovarian cancer before or after chemo

Debulking surgery for advanced stage IIIC or IV ovarian cancer has more or less the same outcomes whether it is performed before or after adjuvant platinum-based chemotherapy, according to the findings of a recent study from Belgium.

Of the 632 women with epithelial ovarian carcinoma, fallopian-tube carcinoma, or primary peritoneal carcinoma eligible to participate, 74.5% had metastatic lesions that were larger than 5 cm in diameter, and 61.6% had lesions larger than 10 cm in diameter.

The researchers found that the hazard ratio (HR) for death in the interval debulking group (those who received neoadjuvant platinum-based chemotherapy followed by debulking surgery) compared with the primary debulking group was 0.98 (90% CI, 0.84-1.13; P=.01 for noninferiority), and the HR for progressive disease was 1.01 (90% CI, 0.89-1.15). Median overall survival was 29 months in the primary group and 30 months in the interval group. Median progression-free survival was 12 months in both groups. The largest remaining tumor mass was 1 cm or less in 80.6% of those who underwent interval debulking compared with 41.6% of the women who received primary debulking.

Vergote I, Tropé CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943-953.