Primary debulking surgery for advanced ovarian cancer: the past, present or future?
Schorge JO, Growdon WG, Munro EG, Del Carmen MG, Boruta DM, Goodman AK. MGH Gynecologic Oncology, Boston
Objective: The efficacy of primary debulking surgery (PDS) for ovarian cancer was initially demonstrated in New England in the late 1970s and became standard of care. More recently, neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS) has been increasingly championed. We reviewed our experience with newly diagnosed advanced ovarian cancer in order to determine our provision of care.
Methods: We prospectively collected data on all women with newly diagnosed stage IIIC/IV epithelial ovarian cancer who underwent primary therapy at MGH from 5/08-5/09. Pathology was reviewed and treatment planning discussed at our weekly multidisciplinary tumor board conference.
Results: 42 patients were treated having a median age of 62 years. 31 patients had stage IIIC disease and 32 had pap serous histology. 35 women (83%) underwent PDS and 7 NACT with IDS. Overall, 64% were optimally debulked to < 1 cm residual disease and there was a trend toward a lower rate in PDS patients (60 v 86%; P = 0.39). Debulking surgery involved lymphadenectomy (31%), bowel resection (29%), splenectomy (17%), and diaphragmatic surgery (14%). Major postoperative morbidity was comparable between PDS and NACT/IDS patients (40 v 28%; P = 0.69). The median day of discharge was 8 (range, 3-28). 11 women (26%) were enrolled in a clinical trial.
Conclusions: Both PDS and NACT/IDS have a role in the initial treatment of women with advanced epithelial ovarian cancer. We hope our data will stimulate discussion of current practice in New England.