Neoadjuvant chemotherapy for advanced epithelial ovarian carcinoma: a retrospective case-control study

Neoadjuvant chemotherapy has been proposed as an alternative approach to primary cytoreductive surgery as initial management of bulky ovarian cancer with the aim of improving surgical efficiency and quality of life. The data of a retrospective case-control study including 75 patients with advanced epithelial ovarian carcinoma Stages IIIC and IV are presented. In 20 patients, neoadjuvant chemotherapy (3-5 cycles of cytostatics) was applied before cytoreductive surgery which was followed by chemotherapy, six cycles in total. In 55 patients cytoreductive surgery was applied as the primary treatment followed by six cycles of chemotherapy. A comparison of both groups of patients showed no significant difference regarding patient age, tumor stage, grade and treatment modality (chemotherapy and surgery, without irradiation) applied cytostatics and total number of chemotherapeutic cycles. The data from our study confirmed a statistically significant difference in radicality of cytoreduction that was more extensive when applied in combination with neoadjuvant chemotherapy than when applied as primary cytoreductive surgery (p = 0.009). No statistically significant difference was found in the survival of the two groups (p = 0.79), the response to primary treatment (p = 0.52), relapse (p = 0.88) or disease-free survival (p = 0.61). From the findings of the study and literature review, we may conclude that neoadjuvant chemotherapy followed by interval debulking surgery in patients with advanced epithelial ovarian carcinoma does not have an unfavorable effect on the prognosis.