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Published in: Archives of Gynecology and Obstetrics 5/2011

01-05-2011 | Gynecologic Oncology

The prognostic significance of optimal debulking in the setting of a complete clinical response for advanced ovarian carcinoma patients receiving maintenance chemotherapy

Authors: Lisa N. Abaid, Bram H. Goldstein, Katrina L. Lopez, John P. Micha, John V. Brown III, Mark A. Rettenmaier, Maurie Markman

Published in: Archives of Gynecology and Obstetrics | Issue 5/2011

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Abstract

Aim

We investigated if optimal surgical debulking increases tumor responsiveness to maintenance chemotherapy and improves survival in advanced ovarian cancer patients who previously attained a clinical complete response (CCR) to primary chemotherapy.

Materials and methods

We retrospectively reviewed 75 advanced ovarian cancer patients, of whom 43 and 32 underwent optimal versus suboptimal cytoreduction, respectively. All patients exhibited a CCR following 6 cycles of paclitaxel and carboplatin and subsequently received maintenance chemotherapy (paclitaxel 135 mg/m2; q21 days).

Results

The median progression free survival (PFS) for the optimally debulked patients was 35 months, compared to 20 months for the suboptimal population (P = 0.003). Moreover, a Cox model analysis revealed that an increased number of maintenance chemotherapy cycles and optimal surgical reduction significantly correlated with favorable patient PFS (P < 0.001). In regard to overall survival (OS), the patients who had optimal cytoreductive surgery exhibited improved OS results compared to the sub-optimal surgery group (42 vs. 27 months; P < 0.001). However, a Cox model analysis indicated that a greater number of maintenance chemotherapy cycles was a surrogate marker for improved OS (P < 0.001), but surgery type was not (P > 0.05). Duration of overall patient follow-up exceeds 41 months.

Conclusion

In advanced ovarian cancer patients who achieve a CCR following induction chemotherapy, optimal cytoreduction may confer a greater clinical benefit from a maintenance approach compared to suboptimal cytoreduction.
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Metadata
Title
The prognostic significance of optimal debulking in the setting of a complete clinical response for advanced ovarian carcinoma patients receiving maintenance chemotherapy
Authors
Lisa N. Abaid
Bram H. Goldstein
Katrina L. Lopez
John P. Micha
John V. Brown III
Mark A. Rettenmaier
Maurie Markman
Publication date
01-05-2011
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 5/2011
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-010-1571-5

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