Treatment outcomes for advanced ovarian cancers with peritoneal dissemination

Purpose: The prognosis of advanced ovarian cancer primarily depends on maximal surgical debulking and chemosensitivity of the tumor. Neo-adjuvant chemotherapy (NAC), maintenance chemotherapy, and interval debulking surgery (IDS) are sometimes used to improve the prognosis of advanced ovarian cancer patients. In this study, we evaluated the outcomes of these therapeutic options in the treatment of FIGO stage III and IV ovarian cancers with intraperitoneal dissemination. Methods: Fifty patients with FIGO stage IIIc and TV ovarian cancer were evaluated. Progression-free survival (PFS) and overall survival (OS) were compared between different patient groups, including patients who underwent optimal surgery versus suboptimal surgery, patients who received NAC versus those who did not, patients who received 6 cycles of postoperative adjuvant chemotherapy versus those who received more than 7 cycles, and patients who underwent IDS versus those who did not. Results: 1) The 5- and 10-year OS rates were 52% and 21%, respectively. 2) Patients in the optimal surgery group experienced significantly longer PFS than patients in the suboptimal surgery group (p=0.04). 3) Although NAC increased the possible rate of optimal surgery from 31.2% to 66.7%, no significant differences in PFS or OS were observed between patients who did and did not receive NAC. 4) Patients who underwent more than 7 cycles of adjuvant chemotherapy after suboptimal surgery experienced significantly longer OS (p=0.001) and a tendency toward longer PFS (p=0.07) compared to patients who received 6 cycles of adjuvant chemotherapy. 5) Patients who achieved a complete response (CR) following adjuvant chemotherapy after suboptimal surgery experienced significantly longer PFS (p=0.001) and OS (p=0.001) compared to patients who did not obtain CR. Moreover, patients who underwent IDS and who did not obtain a CR after adjuvant chemotherapy tended to experience longer PFS than patients who did not undergo IDS (p=0.07). Conclusions: The results of this study are essentially compatible with those of recent randomized controlled trials (RCTs) evaluating NAC, maintenance chemotherapy, and IDS in advanced ovarian cancer. We hope to obtain additional RCT results that will allow improvement of the prognosis of advanced ovarian cancer patients.