• Gynecologic oncology · Feb 2014

    Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness.

    • Vanessa da Costa Miranda, Ângelo Bezerra de Souza Fêde, Carlos Henrique Dos Anjos, Juliana Ribeiro da Silva, Fernando Barbosa Sanchez, Lyvia Rodrigues da Silva Bessa, Jesus de Paula Carvalho, Elias Abdo Filho, Daniela de Freitas, and Maria Del Pilar Estevez Diz.
    • Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.. Electronic address: vamedabc@yahoo.com.br.
    • Gynecol. Oncol. 2014 Feb 1; 132 (2): 287-91.

    ObjectiveThree cycles of neoadjuvant chemotherapy (NACT) followed by interval debulking (ID) surgery is an alternative for patients with advanced ovarian cancer unresectable disease. This study aimed to determine the efficacy and safety of six cycles of NACT followed by cytoreduction.MethodsRetrospective analysis of all patients with advanced epithelial ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma treated with platinum based NACT between January 2008 and February 2012.ResultsEighty-two patients underwent NACT; 78% and 18.2% had extensive stage IIIC or IV disease at diagnosis, respectively. Their median age was 60 years (41-82). On histology, serous adenocarcinoma was found in 90.2%. Patients did not receive chemotherapy after debulking surgery. 35.4% suffered grade 3/4 toxicity; the most commonly observed toxicities were hematologic and nausea. After NACT, 23.1% experienced clinical complete response, 57.4% partial response, and 12.1% disease progression. Complete resection of all macroscopic and microscopic disease (R0) was performed in 63.7%. Surgical complications were uncommon; however, four (6.2%) patients needed a second procedure due to operative complications and 18 (27.3%) needed blood transfusion after debulking. Over a median follow-up period of 19.2 months, median overall survival and chemotherapy-free interval were 37.5 months (confidence interval not reached) and 16 months, respectively.ConclusionSix cycles of neoadjuvant carboplatin and paclitaxel was safe and effective and did not increase perioperative or postoperative complications in patients with stage IIIC/IV disease who were unsuitable for optimal PDS. The overall survival of this cohort was higher than that of those treated with ID surgery.Copyright © 2013 Elsevier Inc. All rights reserved.

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