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Debulking of Ovarian Cancer Can Be Before or After Chemo

In advanced disease, outcome depends mostly on size of residual tumor, not chemotherapy timing

WEDNESDAY, Sept. 1 (HealthDay News) -- Debulking surgery for advanced ovarian cancer results in similar outcomes whether it is done before or after adjuvant chemotherapy, according to a study published in the Sept. 2 issue of the New England Journal of Medicine.

Ignace Vergote, M.D., of the University Hospitals Leuven in Belgium, and colleagues conducted a randomized study of 632 patients with stage IIIC or IV epithelial ovarian carcinoma, fallopian-tube carcinoma, or primary peritoneal carcinoma after assigning them to primary debulking surgery followed by platinum-based chemotherapy or to neoadjuvant platinum-based chemotherapy followed by debulking surgery (interval debulking surgery).

The researchers found that the hazard ratio (HR) for death in the interval debulking group as compared to the primary debulking group was 0.98 (P = 0.01 for non-inferiority); the HR for progressive disease was 1.01. The largest remaining tumor mass was 1 cm or less in 80.6 percent of those who underwent interval debulking, compared to 41.6 percent of the primary debulking group. In both groups, the strongest variable associated with overall survival was the complete resection of all macroscopic disease.

"Neoadjuvant chemotherapy is not inferior to primary cytoreductive surgery for patients with stage IIIC or IV ovarian carcinoma. No significant advantages of neoadjuvant therapy or primary debulking surgery were observed with respect to survival, adverse effects, quality of life, or postoperative morbidity or mortality," the authors write.

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