Role of primary surgery for persistent residual disease after more than 5 cycles of chemotherapy for primary advanced ovarian cancer

Background:

Standard of care in patients with advanced ovarian cancer is upfront surgery followed by chemotherapy. An interval debulking after 3 chemotherapy-cycles might be an alternative in selected patients. Some patients attend a referral center after having received 5+ cycles of neoadjuvant chemotherapy with persistent disease. So far, the role of a „delayed-interval-debulking“ (DID) is poorly defined.

Methods:

Retrospective analysis of our prospective registry database 2011 – 2017 of patients with advanced epithelial ovarian cancer and DID for persistent disease after 5+ cycles NACT.

Results:

39 patients underwent DID. 92.3% had a serous high-grade ovarian cancer. The median number of pre-OP cycles was 6 (range 5 – 8). Median Peritoneal-Cancer-Index was 11, median duration of surgery 285 minutes (range 80 – 510). Complete resection was achieved in 84.6%. 53.8% underwent a bowel resection. The median surgical complexity score was 7 (2 – 16), the rate of severe complications (Clavien-Dindo grade 3/4) was 23.1%; we observed no post-operative mortality. The median number of chemotherapy cycles post-surgery was 2 (range 0 – 4), 16 (41.0%) patients received maintenance therapy with bevacizumab. The median PFS and OS in patients with complete resection was 17.2 and 49 months in contrast to 6.4 and 14 months in patients with incomplete resection.

Conclusion:

DID might be an option for patients having missed successful upfront surgery or interval debulking following 3 courses NACT. However, it should be restricted to selected patients in whom the probability for achieving a complete resection is high. DID resulting in incomplete resection is associated with very poor prognosis and shouldn't be performed.