Interval debulking surgery for advanced epithelial ovarian cancer

Tangjitgamol S, Manusirivithaya S, Laopaiboon M, Lumbiganon P, Bryant A

Published Online:

October 6, 2010

Ovarian cancer frequently presents at an advanced stage so it may not be possible to remove all tumours during surgery. Several cycles of chemotherapy are generally given after primary surgery. Secondary surgery, performed after a few cycles of chemotherapy before further cycles of chemotherapy, is called interval debulking surgery (IDS). This review compares the survival of patients with advanced epithelial ovarian cancer, who had IDS performed between cycles of chemotherapy after primary surgery with survival of patients who had conventional treatment (primary debulking surgery and adjuvant chemotherapy). It found similar survival rates in patients who did and did not receive IDS. No adequate information regarding adverse effects was available. Data on quality of life (QoL) of the patients were also inconclusive.

Abstract (click to read)

Background:

Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a possible role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option.

Objectives:

To assess the effectiveness and complications of IDS for patients with advanced stage epithelial ovarian cancer.

Search strategy:

We searched the Cochrane Gynaecological Cancer Group's Specialised Register to July 2009, the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2009, MEDLINE from January 1966 to June week 4 2009, and EMBASE from January 1966 to week 27 2009.

Selection criteria:

Randomised controlled trials (RCTs) comparing survival of women with advanced epithelial ovarian cancer, who had IDS performed between cycles of chemotherapy after primary surgery with survival of women who had conventional treatment (primary debulking surgery and adjuvant chemotherapy).

Data collection and analysis:

Two review authors independently assessed trial quality and extracted data. Searches for additional information from study authors were attempted. Meta-analysis of overall and progression-free survival (PFS) were performed using random-effects models.

Main results:

Three RCTs randomising 853 women, of whom 781 were evaluated, met the inclusion criteria. Meta-analysis of three trials for overall survival (OS) found no statistically significant difference between IDS and chemotherapy alone (hazard ratio (HR) = 0.80, 95% confidence interval (CI) 0.61 to 1.06, I2 = 58%). Subgroup analysis for OS in two trials, where the primary surgery was not performed by gynaecologic oncologists or was less extensive, showed a benefit of IDS: HR = 0.68, 95% CI 0.53 to 0.87, I2 = 0%). Meta-analysis of two trials for progression-free survival (PFS) found no statistically significant difference between IDS and chemotherapy alone (HR = 0.88, 95% CI 0.57 to 1.33, I2 = 83%). Rates of toxic reactions to chemotherapy were similar in both arms (risk ratio = 1.19, 95% CI 0.53 to 2.66, I2 = 0%), but little information was available for other adverse events or quality or life.

Authors' conclusions:

No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in patients whose primary surgery was not performed by gynaecologic oncologists or was less extensive. Data on QoL and adverse events were inconclusive.

This record should be cited as:

Tangjitgamol S, Manusirivithaya S, Laopaiboon M, Lumbiganon P, Bryant A. Interval debulking surgery for advanced epithelial ovarian cancer. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD006014. DOI: 10.1002/14651858.CD006014.pub5

Assessed as up to date:

August 19, 2010

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Gynaecological Cancer Group

Health topics:

Cancer > Gynaecological > Ovary

Gynaecology > Cancer > Ovary

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interval debulking surgery for advanced epithelial ovarian cancer

More like this

Copyright © 2012 - The Cochrane Collaboration