Chapters authored
Treatment Decisions and Survival in Ovarian Cancer
Objective: to review the most recent data on the impact of the primary treatment and individual factors on ovarian cancer patient survival and to study it in a real world population. Methods/materials: retrospective analysis of 147 consecutive ovarian cancer patients treated with platin-based chemotherapy, either after primary debulking surgery (PDS) (n = 94, 64%) or as neoadjuvant (NACT) treatment (53, 36%). Results: NACT patients were older (64.3 vs. 58.2 years), with radiologically unresectable disease (74%) and/or comorbidities (26%). Fifty-five percent of pts. submitted to PDS were staged III/IV. Serous carcinomas were equally distributed (PDS-57% vs. NACT-60%) but endometrioid (20 vs. 4%) and carcinomas not otherwise specified (6 vs. 30%) were more frequently diagnosed in the PDS and NACT group, respectively. Genetic diagnosis (24.4%): 11 BRCA1/2 and 1 RAD51C carriers identified. Residual disease after surgery was the only significant prognostic factor for both relapse (HR = 2267) and death (HR = 1847). Primary debulking surgery was associated with a significantly better PFS (HR = 0.541; p = 0.012) and with a trend to a better OS (HR = 0.714; p = 0.296). For pts. with III/IV disease OS was significantly superior in the PDS group. Conclusion: residual disease was the only significant prognostic factor. Primary surgery was associated with a significantly better PFS. The difference in OS was significant in stage III/IV patients. This reinforces the importance of maximal cytoreduction.
Part of the book: Cancer Management and Therapy