gms | German Medical Science

Background: In the past years the concept of neoadjuvant chemotherapy followed by laparotomy has emerged for patients with advanced ovarian cancer and unfavorable prognosis (e.g. diffuse peritoneal carcinosis). In a recent study on neoadjuvant chemotherapy higher tumor resection rates and longer median survival were demonstrated in patients with advanced ovarian carcinoma and ascites >500ml. Most studies use three cycles of preoperative chemotherapy. However, chemoresistant tumorclones may be induced by increasing number of preoperative chemotherapy cycles. The purpose of this study is to evaluate the optimal number of cycles prior to interval laparotomy.

Material and Methods: 67/73 patients with advanced serous ovarian carcinoma (FIGO IIIc n=48, FIGO IV n=19) and ascites >500ml were randomized into two arms, receiving either 2 (n=33) or 3 (n=34) cycles of Carboplatin (AUC5) and Docetaxel (75mg/m2) before debulking surgery. Postoperatively, they received either 4 or 3 additional cycles. Response rate, postoperative residual tumor and quality of life (QOL) were evaluated.

Results: Surgical response was assessed during interval laparotomy. At present 32 patients underwent tumordebulking. Partial remission was observed in 28/32 patients irrespective of the number of preoperative chemotherapy cycles. Two patients in each arm showed stable disease. Optimal cytoreduction was achieved in 25/32 patients. No severe adverse events were reported and QOL improved considerably during preoperative chemotherapy. Six of 73 patients were not eligible. Two patients were excluded due to therapy-unrelated events. In 4 patients ovarian cancer was excluded by laparoscopy prior to neoadjuvant chemotherapy.

Conclusions: Neoadjuvant chemotherapy followed by laparotomy was safe and well tolerated. Diagnostic laparoscopy prior to neoadjuvant chemotherapy allowed differentiation of primary ovarian cancers from tumors of other origin. In these cases laparotomy could be circumvented. Optimal tumor reduction was achieved in a significant number of patients. Response rate, postoperative residual tumor and QOL were essentially the same in both arms. Our data indicate that two cycles of preoperative chemotherapy may be the preferential choice of therapy for future studies.