Can surgical debulking reverse platinum resistance in patients with metastatic epithelial ovarian cancer?

To examine the impact of delayed primary interval surgical debulking in women with ovarian cancer who show resistance to neoadjuvant platinum-based chemotherapy.

We carried out retrospective chart reviews to identify women treated for ovarian cancer between 1997 and 2005 who were resistant to neoadjuvant platinum-based chemotherapy based on CA-125 criteria. "Platinum resistance" was defined as having a decrease in serum CA-125 of less than 50% after three cycles of chemotherapy from the time of initial diagnosis. Associations between residual disease and platinum sensitivity status at time of first recurrence were identified using chi-square tests. Median progression-free interval was estimated using the Kaplan Meier method.

Ninety-one women were treated with neoadjuvant chemotherapy. Seventeen patients met the criteria for platinum resistance after neoadjuvant chemotherapy. The mean decline in serum CA-125 levels was 18.2%. All patients underwent attempts at surgical debulking. Optimal debulking was achieved in 10 patients (59%). There was a significant association between decreasing amount of residual disease and improving clinical response after primary treatment (P=0.007), and with platinum sensitivity status at the time of first recurrence (P=0.023). The estimated median progression free survival was 10.7 months.

In women with ovarian cancer who have demonstrated platinum resistance after primary neoadjuvant chemotherapy, optimal tumour debulking can further improve response to subsequent platinum-based chemotherapy and prognosis.