Debulking surgery may be beneficial because it can reduce the number of cancer cells that ultimately need to be destroyed by chemotherapy and, therefore, diminish the likelihood of cancers developing a resistance to chemotherapy. The value of debulking surgery in ovarian cancer has been extensively debated for years although it has become the “de facto” standard of care. Doctors from Europe have reported in the
New England Journal of Medicine the results of the first significant comparative trial directly evaluating surgical debulking as part of an overall treatment study for women with advanced ovarian cancer.
In this clinical study, women with stage IIB to IV ovarian cancer that were optimally surgically debulked at diagnosis were enrolled in a clinical trial evaluating whether additional debulking surgery could improve their outcome. Patients were initially treated with 3 cycles of cyclophosphamide and cisplatin chemotherapy and then reevaluated. Patients that had no evidence of progressive cancer were randomly assigned to receive additional debulking surgery or no additional surgery. All patients were then treated with 3 additional cycles of cyclophosphamide and cisplatin.
Women that underwent interval debulking surgery following 3 cycles of cisplatin and cyclophosphamide chemotherapy survived longer and experienced a delayed time to cancer recurrence than women not treated with interval debulking surgery. On average, women treated with interval debulking survived 26 months compared to 20 months and were alive without evidence of cancer recurrence for 18 months compared to 13 months for women not treated with interval debulking. Two years from treatment, 56% of women treated with interval debulking survived compared to only 46% not treated with debulking surgery. Approximately 15% of patients experienced complications from the interval debulking surgery, although these complications were minor in nature.
In summary, this is the largest clinical trial directly evaluating the role of interval debulking surgery in women with advanced ovarian cancer. This clinical trial demonstrates that women treated with interval debulking surgery following initial chemotherapy treatment are more likely to live longer and experience a longer time until cancer recurrence than women not treated with interval debulking surgery. Additional confirmatory studies evaluating the role of interval debulking surgery are currently ongoing as are clinical trials evaluating the optimal time to perform interval debulking surgery. (New England Journal of Medicine, Vol 332, No 10, pp 629-634) 1995