The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer

Maria E L Van Der Burg, Mat Van Lent, Marc Buyse, Anna Kobierska, Nicoeetta Colombo, Giuseppe Favalli, Angel J. Lacave, Mario Nardi, Josette Renard, Sergio Pecorelli

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Abstract

Background. Although the value of primary cytoreductive surgery for epithelial ovarian cancer is beyond doubt, the value of debulking surgery after induction chemotherapy has not yet been defined. In this randomized study we investigated the effect on survival of debulking surgery. Methods. Eligible patients had residual lesions measuring more than 1 cm in diameter after primary surgery. After three cycles of cyclophosphamide and cisplatin, these patients were randomly assigned to undergo either debulking surgery or no surgery, followed by further cycles of cyclophosphamide and cisplatin. The study end points were progression-free survival and overall survival. At surgery 65 percent of the patients had lesions measuring more than 1 cm. In 45 percent of this group, the lesions were reduced surgically to less than 1 cm. Results. Of the 319 patients who underwent randomization, 278 could be evaluated (140 patients who underwent surgery and 138 patients who did not). Progression-free and overall survival were both significantly longer in the group that underwent surgery (P=0.01). The difference in median survival was six months. The survival rate at two years was 56 percent for the group that underwent surgery and 46 percent for the group that did not. In the multivariate analysis, debulking surgery was an independent prognostic factor (P=0.012). Overall, after adjustment for all other prognostic factors, surgery reduced the risk of death by 33 percent (95 percent confidence interval, 10 to 50 percent; P=0.008). Surgery was not associated with death or severe morbidity. Conclusions. Debulking surgery significantly lengthened progression-free and overall survival. The risk of death was reduced by one third, after adjustment for a variety of prognostic factors.

Original languageEnglish
Pages (from-to)629-634
Number of pages6
JournalNew England Journal of Medicine
Volume332
Issue number10
DOIs
Publication statusPublished - Mar 9 1995

ASJC Scopus subject areas

  • Medicine(all)

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    Van Der Burg, M. E. L., Van Lent, M., Buyse, M., Kobierska, A., Colombo, N., Favalli, G., Lacave, A. J., Nardi, M., Renard, J., & Pecorelli, S. (1995). The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. New England Journal of Medicine, 332(10), 629-634. https://doi.org/10.1056/NEJM199503093321002