RESUMEN
BACKGROUND: There is a lack of clinical data on the validity of neoadjuvant chemotherapy in the treatment of ovarian cancer. The aim of this study was to compare the impact of the adjuvant and neoadjuvant chemotherapy regimens on the clinical outcomes in patients with advanced ovarian cancer. METHODS: We performed a retrospective analysis of 574 patients with advanced ovarian cancer admitted to four Lithuanian oncogynaecology departments during 1993-2000. The conventional combined treatment of cytoreductive surgery and platinum-based chemotherapy was applied to both the group that underwent neoadjuvant chemotherapy (n = 213) and to the control group (n = 361). The selection criterion for neoadjuvant chemotherapy was large extent of the disease. Overall and progression-free survival rates and survival medians were calculated using life tables and the Kaplan-Meier method. RESULTS: There was no difference in median overall survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (25.9 months vs. 29.3 months, p = 0.2508) and stage IV patients (15.4 months vs. 14.9 months, p = 0.6108). Similarly, there was no difference in median progression-free survival between stage III patients treated with adjuvant chemotherapy and neoadjuvant chemotherapy (15.7 months vs. 17.5 months, p = 0.1299) and stage IV patients (8.7 months vs. 8.2 months, p = 0.1817). There was no difference in the rate of the optimal cytoreductive surgery between patients who underwent the neoadjuvant chemotherapy and patients primarily treated with surgery (n = 134, 63% vs. n = 242, 67%, respectively). CONCLUSION: There was no difference in progression-free or overall survival and in the rate of optimal cytoreductive surgery between the neoadjuvant and adjuvant chemotherapy groups despite the fact that patients receiving neoadjuvant chemotherapy had a more extensive disease. Multivariate analysis failed to prove that neoadjuvant chemotherapy could be considered as an independent prognostic factor for survival, and the findings need to be investigated in the future prospective randomised studies.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Anciano , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante , Neoplasias Ováricas/cirugía , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate if preoperative radiotherapy influences course of operation (radical hysterectomy and lymphadenectomy) and postoperative period in series of stage IB-IIA cervical carcinomas. METHODS: Retrospective comparative study was performed. During the study we analyzed 101 case histories of patients who underwent radical type II hysterectomy with lymphadenectomy in Kaunas University of Medicine Hospital and Kaunas Hospital of Oncology between 1995 and 2002. RESULTS: Mean operation time was shorter, hemoglobin and hematocrit values after operation were better, stay in hospital was longer, demand for narcotic analgetics was bigger, function of ovaries was maintained more rarely (p<0.05) in the group of patients undergoing preoperative radiotherapy. The number of patients requiring transfusions and count of complications were similar in both groups (p>0.05). CONCLUSION: In our study, preoperative radiotherapy did not seem to complicate course of radical hysterectomy.
Asunto(s)
Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Estudios de Casos y Controles , Cuello del Útero/patología , Interpretación Estadística de Datos , Femenino , Humanos , Histerectomía/métodos , Tiempo de Internación , Escisión del Ganglio Linfático , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Preoperatorios , Radioterapia Adyuvante , Estudios Retrospectivos , Factores de Tiempo , Neoplasias del Cuello Uterino/patologíaRESUMEN
Primary cytoreductive surgery remains the standard care in advanced ovarian cancer. Optimal cytoreductive surgery is defined as a residual tumor load less than 1 cm. after operation. The randomized clinical trials showed that interval debulking surgery improved survival in patients who did not undergo optimal primary debulking surgery. The retrospective trials have suggested that the outcome for patients treated with neoadjuvant chemotherapy followed by interval debulking surgery is the same as for patients treated with primary debulking surgery followed by adjuvant chemotherapy. The neoadjuvant chemotherapy should not to be used for clinical practice until the randomized clinical trial carried out by Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer and National Cancer Institute of Canada answers this question. There are no data from randomized trials to show the survival advantage in patients who received second-look operation as compared to those who did not.