IMMEDIATE AND LONG-TERM OUTCOMES OF COMPREHENSIVE TREATMENT FOR PATIENTS WITH OVARIAN CANCER STAGE III-IV

Hrytsyk¹, A. Kryzhanivska¹^,²

¹Ivano-Frankivsk National Medical University,

²Municipal Non-Profit Enterprise «Prykarpattia Clinical Oncology Center of the Ivano-Frankivsk Regional Council», Ivano-Frankivsk, Ukraine

DOI: https://doi.org/10.15407/oncology.2024.03.203

Summary. Aim:to evaluate the immediate treatment outcomes and overall and relapse-free survival of patients with ovarian cancer stage III-IV depending on the treatment method. Object and methods: the study presents the overall and relapse-free survival results of 269 patients with ovarian cancer stage III-IV who received comprehensive treatment at the “Prykarpattia Clinical Oncology Center of the Ivano-Frankivsk Regional Council” between 2017 and 2023. Patients were divided into 3 groups based on the treatment method: Group I – primary cytoreductive surgery followed by 6 adjuvant cycles of polychemotherapy (PCT); Group II – three neoadjuvant cycles of PCT, interval cytoreductive surgery, and adjuvant PCT; Group III – 6 cycles of PCT. All patients received chemotherapy following the paclitaxel-carboplatin regimen. Results: in all groups, 19 (7%) cases of platinum-resistant ovarian cancer were identified, and the treatment outcomes for these patients were not included in survival calculations. The 3-year overall cumulative survival rate was 50% in group I, 58% in group II, and 36% in group III. The median overall survival in group I was 31 months, in group II – 37 months, and in group III – 17 months. The 3-year relapse-free cumulative survival was 24% in group I, 48% in group II, and 36% in group III. The median relapse-free survival in group I was 19 months, in group II – 25 months, and in group III – 17 months. Conclusions: relapse-free and overall survival rates were significantly better in patients who received comprehensive treatment compared to those who only underwent chemotherapy cycles. The use of neoadjuvant chemotherapy in patients with stage III-IV ovarian cancer improves relapse-free survival but does not affect overall survival compared to patients who underwent primary cytoreductive surgery.

Keywords: ovarian cancer, radiation diagnostics, peritoneal carcinomatosis index, neoadjuvant chemotherapy, polychemotherapy, cytoreductive surgery, overall survival, relapse-free survival.

References

1. Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: A review. Cancer Biol Med 2017; 14(1): 9–32. doi: 10.20892/j.issn.2095-3941.2016.0084.
2. Estimates of cancer incidence and mortality in 2020, for all cancer sites. European Cancer Information System. https://ecis.jrc.ec.europa.eu/index.php.
3. European Institute of Women’s Health. Ovarian cancer: a silent killer. Eurohealth. https://eurohealth.ie/policy‐brief‐women‐and‐ovarian‐cancer‐in‐the‐eu‐2018/.
4. Colombo N, Sessa C, du Bois A, et al. ESMO‐ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol 2019; 30(5): 672–705. doi: 10.1093/annonc/mdz062.
5. 5. Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; 386(9990): 249– doi: 10.1016/S0140-6736(14)62223-6.
6. 6. Vergote I, Trope CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010; 363(10): 943– doi: 10.1056/NEJMoa0908806.
7. 7. Onda T, Satoh T, Saito T, et al. Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. Eur J Cancer 2016; 64: 22– doi: 10.1016/j.ejca.2016.05.017.
8. 8. Fagotti A, Ferrandina G, Vizzielli G, et al. Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): Final analysis of peri-operative outcome. Eur J Cancer 2016; 59: 22– doi: 10.1016/j.ejca.2016.01.017.
9. 9. Liu EL, Mi RR, Wang DH, et al. Application of combined intraperitoneal and intravenous neoadjuvant chemotherapy in senile patients with advanced ovarian cancer and massive ascites. Eur J Gynaecol Oncol 2017; 38(2): 209– https://www.ncbi.nlm.nih.gov/pubmed/29953782.
10. 10. van Meurs HS, Tajik P, Hof MH, et al. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer 2013; 49(15): 3191– doi: 10.1016/j.ejca.2013.06.013.
11. 11. Tajik P, van de Vrie R, Zafarmand MH, et al. The FIGO stage IVA versus IVB of ovarian cancer: Prognostic value and predictive value for neoadjuvant chemotherapy. Int J Gynecol Cancer 2018; 28(3): 453– doi: 10.1097/IGC.0000000000001186.
12. 12. Vergote I, Coens C, Nankivell M, et al. Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials. Lancet Oncol 2018; 19(12): 1680– doi: 10.1016/S1470-2045(18)30566-7.
13. du Bois A, Reuss A, Pujade-Lauraine E,  et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009; 115(6): 1234–44. doi: 10.1002/cncr.24149.