Neoadjuvant May Allow More Optimal Treatment of Patients with Ovarian Cancer

Neoadjuvant Chemotherapy May Allow More Optimal Treatment of Patients with Ovarian Cancer

Neoadjuvant chemotherapy (treatment prior to surgery) may allow some patients with inoperable advanced ovarian cancer to undergo surgical removal of their cancer, according to a recent article in the journal Cancer.

Ovarian cancer is a common malignancy occurring in women in the United States, with about 25,000 new cases diagnosed each year. The ovary makes female hormones and stores all the eggs that are released once a month during ovulation. There are two ovaries, one on each side of the uterus. The earlier ovarian cancer is detected, the higher the cure rate. Unfortunately, because ovarian cancer begins deep in the pelvis and often does not cause any symptoms until advanced stages, the disease often goes unnoticed until it has reached a stage where it is incurable. Most women with ovarian cancer have advanced disease at the time of diagnosis. This means the cancer has spread from the ovary to other body locations within the abdomen, such as the surface or inside of the liver, intestine, or lymph nodes. Although treatment outcomes have improved for women with advanced ovarian cancer, overall survival for these patients is poor.

One essential treatment component for patients with advanced ovarian cancer is the surgical removal of all detectable cancer without damaging necessary organs and/or tissue in the abdomen (surgical debulking). Optimal surgical debulking refers to the removal of cancer with less than 1cm to 2cm of remaining cancer. Even if all visible cancer is able to be removed during surgical debulking, 60% to 80% patients with advanced ovarian cancer still experience a cancer recurrence following surgery. This is due to the undetectable cancer cells that remain in the body following surgery. Therefore, patients normally receive chemotherapy following surgery in an attempt to eradicate undetectable cancer cells. Unfortunately, advanced ovarian cancer is often considered inoperable, meaning the patient would suffer extreme morbidity and/or gain no benefit from surgery due to the size, number and/or location of the cancer.

Physicians from 5 French Cancer Centers recently evaluated treatment and outcomes of neoadjuvant chemotherapy in 54 women with advanced ovarian cancer who were treated at their facilities between 1996 and 1999. All women were initially considered inoperable. Following neoadjuvant chemotherapy, 43 patients (80%) achieved an anti-cancer response. Of these responders, 91% were subsequently able to undergo optimal surgical debulking, meaning the greatest size of cancer not able to be surgically removed was less than 2cm. Patients that were non-responsive to chemotherapy were spared extensive surgery. Survival time following treatment was improved for patients who responded to neoadjuvant therapy and underwent subsequent debulking. It is not clear from this study whether or not overall survival for the entire group was improved. However, this approach to the treatment of ovarian cancer will be studied in future clinical trials to determine its exact role in the management of advanced ovarian cancer. Patients with advanced ovarian cancer may wish to speak with their physician about the risks and benefits of neoadjuvant chemotherapy or participation in a clinical trial evaluating other promising therapeutic approaches.

(Cancer, Vol 91, Issue 12, pp 2329-2334)

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