A Prospective Observational Study of the Efficacy of Neoadjuvant Chemotherapy in Newly Diagnosed Inoperable Patients of Epithelial Ovarian Cancer

Introduction: Ovarian cancer is the leading cause of death from gynecological cancers in developed countries. More than 70% of patients have Stage III – IV disease at diagnosis. The standard of care for advanced ovarian cancer is primary debulking surgery (PDS) followed by adjuvant (ADJ) chemotherapy. There are very few prospective randomized Indian studies that have evaluated the effectiveness of neoadjuvant chemotherapy (NACT) in advanced ovarian cancer. This study attempted to evaluate the efficacy of NACT in advanced epithelial ovarian cancer patients who were unfit for upfront surgery.

Methods: This was a prospective observational study involving newly diagnosed patients with inoperable epithelial ovarian cancer, conducted over a period of 18 months from October 2016 to March 2018 at the department of Medical Oncology at a tertiary care oncology center, situated in Hyderabad, India. Detailed clinical history, laboratory reports, imaging and histopathological reports were obtained and maintained in a standard proforma.

Results: The median age at presentation was 51 years with a range of 37 to 70 years. 82.8% of the cases belonged to international federation of obstetrics and gynecology (FIGO) stage III. The objective response rate to NACT was 85.93% and the optimal cytoreduction rate was 85.96%. Post operative grade 3 or 4 adverse events were observed in 19.3% of the patients.

Conclusion: Neoadjuvant chemotherapy is an alternative approach to primary debulking surgery for advanced ovarian cancers. Among inoperable advanced epithelial ovarian cancer patients, neoadjuvant chemotherapy is associated with good objective response rates. Patients undergoing interval debulking surgery following neoadjuvant chemotherapy had less peri-operative morbidity and mortality.