The impact of number of cycles of neoadjuvant chemotherapy on survival of patients undergoing interval debulking surgery for stage IIIC-IV unresectable ovarian cancer: Results from a multi-institutional study

Giorgio Bogani, Laura Matteucci, Stefano Tamberi, Valentina Arcangeli, Antonino Ditto, Giuseppa Maltese, Mauro Signorelli, Fabio Martinelli, Valentina Chiappa, Umberto Leone Roberti Maggiore, Stefania Perotto, Cono Scaffa, Giuseppe Comerci, Marco Stefanetti, Francesco Raspagliesi, Domenica Lorusso

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Abstract

Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Methods Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Results Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95-3.22; P = 0.06). Conclusion Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

Original languageEnglish
Pages (from-to)1856-1862
Number of pages7
JournalInternational Journal of Gynecological Cancer
Volume27
Issue number9
DOIs
Publication statusPublished - Nov 1 2017

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Ovarian Neoplasms
Drug Therapy
Survival
Confidence Intervals
Disease-Free Survival
Multivariate Analysis
Prospective Studies

Keywords

  • Interval debulking surgery
  • Neoadjuvant chemotherapy
  • Number cycles
  • Ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

The impact of number of cycles of neoadjuvant chemotherapy on survival of patients undergoing interval debulking surgery for stage IIIC-IV unresectable ovarian cancer : Results from a multi-institutional study. / Bogani, Giorgio; Matteucci, Laura; Tamberi, Stefano; Arcangeli, Valentina; Ditto, Antonino; Maltese, Giuseppa; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Leone Roberti Maggiore, Umberto; Perotto, Stefania; Scaffa, Cono; Comerci, Giuseppe; Stefanetti, Marco; Raspagliesi, Francesco; Lorusso, Domenica.

In: International Journal of Gynecological Cancer, Vol. 27, No. 9, 01.11.2017, p. 1856-1862.

Research output: Contribution to journalArticle

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abstract = "Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Methods Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Results Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40{\%}), 74 (38{\%}), and 43 (22{\%}) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95{\%} confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95{\%} CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46{\%} and 31{\%} for patients having 3 and at least 4 cycles. Ten-year overall survival was 26{\%} and 18{\%} for patients having 3 and at least 4 cycles (HR, 1.70; 95{\%} CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95{\%} CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95{\%} CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95{\%} CI, 0.95-3.22; P = 0.06). Conclusion Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.",
keywords = "Interval debulking surgery, Neoadjuvant chemotherapy, Number cycles, Ovarian cancer",
author = "Giorgio Bogani and Laura Matteucci and Stefano Tamberi and Valentina Arcangeli and Antonino Ditto and Giuseppa Maltese and Mauro Signorelli and Fabio Martinelli and Valentina Chiappa and {Leone Roberti Maggiore}, Umberto and Stefania Perotto and Cono Scaffa and Giuseppe Comerci and Marco Stefanetti and Francesco Raspagliesi and Domenica Lorusso",
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T1 - The impact of number of cycles of neoadjuvant chemotherapy on survival of patients undergoing interval debulking surgery for stage IIIC-IV unresectable ovarian cancer

T2 - Results from a multi-institutional study

AU - Bogani, Giorgio

AU - Matteucci, Laura

AU - Tamberi, Stefano

AU - Arcangeli, Valentina

AU - Ditto, Antonino

AU - Maltese, Giuseppa

AU - Signorelli, Mauro

AU - Martinelli, Fabio

AU - Chiappa, Valentina

AU - Leone Roberti Maggiore, Umberto

AU - Perotto, Stefania

AU - Scaffa, Cono

AU - Comerci, Giuseppe

AU - Stefanetti, Marco

AU - Raspagliesi, Francesco

AU - Lorusso, Domenica

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Methods Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Results Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95-3.22; P = 0.06). Conclusion Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

AB - Objectives Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Methods Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Results Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95-3.22; P = 0.06). Conclusion Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

KW - Interval debulking surgery

KW - Neoadjuvant chemotherapy

KW - Number cycles

KW - Ovarian cancer

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