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Prolonged interruption of chemotherapy in patients undergoing delayed debulking surgery for advanced high grade serous ovarian cancer is associated with a worse prognosis.
Searle, Gemma; Pounds, Rachel; Phillips, Andrew; Kehoe, Sean; Balega, Janos; Singh, Kavita; Yap, Jason.
Afiliação
  • Searle G; Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
  • Pounds R; Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, United Kingdom.
  • Phillips A; University Hospitals of Derby and Burton, Royal Derby Hospital, Department of Gynaecology, Uttoxeter Road, Derby DE22 3NE, United Kingdom.
  • Kehoe S; Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, United Kingdom.
  • Balega J; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, United Kingdom.
  • Singh K; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, United Kingdom.
  • Yap J; Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, United Kingdom. Electronic address: j.yap@bham.ac.uk.
Gynecol Oncol ; 158(1): 54-58, 2020 07.
Article em En | MEDLINE | ID: mdl-32345546
INTRODUCTION: The current standard of care for advanced high grade serous ovarian cancer (HGSC) comprises a combination of debulking surgery and platinum-based chemotherapy given in the neoadjuvant or adjuvant setting. In the neoadjuvant setting, patients usually undergo 3 cycles of chemotherapy followed by interval cytoreductive surgery (ICS), then 3 further cycles of chemotherapy. However, the optimum timeframe to administer chemotherapy before and after ICS remains unclear. We therefore examine the survival impact of the interval between pre- and post-operative chemotherapy in patients undergoing ICS in a well-established patient cohort. Factors leading to "delays" in recommencing post-operative chemotherapy were also examined. METHODS: The study comprises of a retrospective cohort of 205 cases with FIGO stage III and IV HGSC undergoing ICS. The duration of the interval between pre-operative and post-operative chemotherapy was correlated with progression-free (PFS) and overall survival (OS). Univariate and multivariate analyses were constructed to identify factors associated with survival and prolonged chemotherapy interruption. RESULTS: The median interval between pre-operative and post-operative chemotherapy was 63 days. Multivariate analyses revealed macroscopic residual disease (HR:2.280, 95% CI:1.635-3.177, p ≤ 0.001) and interruption of chemotherapy >10 weeks (HR:1.65, 95%CI:1.201-2.290, p = 0.002) were associated with poorer OS. Existing medical comorbidities and longer hospital stay were independent prognostic factors for prolonging the chemotherapy interruption. CONCLUSION: Our study recommends that interruption to chemotherapy to allow patients to undergo ICS should be ≤10 weeks; otherwise, OS is significantly impacted. Patients with pre-existing medical comorbidities should receive additional support pre- and post-operatively to keep the chemotherapy interruption to a minimum.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Ovarianas / Protocolos de Quimioterapia Combinada Antineoplásica / Cistadenocarcinoma Seroso Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Ovarianas / Protocolos de Quimioterapia Combinada Antineoplásica / Cistadenocarcinoma Seroso Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article