Neoadjuvant Chemotherapy and Interval Debulking in Ovarian Malignancy

Introduction: Primary debulking surgery followed by chemotherapy is the treatment for advanced stage ovarian malignancy but has limited efficacy when optimal cytoreduction is not achieved at the end of the surgical procedure. Neoadjuvant chemotherapy could significantly reduce tumour burden before surgery and allow easier and optimal cytoreduction in patients with advanced and primarily unresectable ovarian carcinoma. Objectives: The purpose of this retrospective study was to report our experience of neoadjuvant chemotherapy and interval debulking in patients with primary unresectable ovarian malignancy who presented in the gynaecological outpatient department at Christian Medical College, Vellore. Material&Methods: Between July 2004 and September 2006, forty-four patients with advanced stage of ovarian malignancy in which the tumour was deemed unresectable on clinical or imaging criteria, received three to six cycles of neoadjuvant chemotherapy. Debulking was performed when patients showed a good clinical, biochemical, imaging response to chemotherapy, followed by additional cycles of chemotherapy. Patient characteristics, response to neoadjuvant chemotherapy, optimal cytoreduction achieved, post operative hospital stay, remission and recurrence rates were noted. Results: Optimal cytoreduction was possible in 77.3% of the patients after neoadjuvant chemotherapy with less aggressive interval debulking surgery and little postoperative morbidity. Conclusion: Neoadjuvant chemotherapy for primary advanced (stage III/IV) ovarian carcinoma leads to selection of a subset of patients sensitive to chemotherapy in which optimal cytoreduction can be achieved after chemotherapy. It permits less aggressive surgery and improves operability.