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Interval debulking surgery for advanced epithelial ovarian cancerTangjitgamol S, Manusirivithaya S, Laopaiboon M, Lumbiganon P
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SummaryInterval debulking surgery for advanced epithelial ovarian cancerOvarian 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 08. 2008 AbstractBackgroundPrimary debulking surgery, a crucial step in the management of epithelial ovarian cancer, is not always an option in patients with advanced stage disease (stage III to IV). In some circumstances, surgery may not yield satisfactory results with residual tumour masses > 1 to 2 cm (so called suboptimal surgery). Induction or neoadjuvant chemotherapy followed by interval debulking surgery (IDS) may have an alternative role in this setting. However, the advantage of IDS compared to conventional methods is still a controversial issue. ObjectivesTo assess the effectiveness and complications of IDS for patients with advanced stage epithelial ovarian cancer. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 2, 2008), MEDLINE (January 1966 to June 2008), EMBASE (January 1966 to June 2008), and reference lists of included studies. Selection criteriaRandomised 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 analysisTwo 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) was performed using fixed effects models. Main resultsThree RCTs, randomising 853 women of whom 781 were evaluated, met the inclusion criteria. Overall survival (OS) showed substantial heterogeneity between trials (I2 = 58%). Subgroup analysis for overall survival in two trials, wherein the primary surgery was not performed by gynecologic oncologists or was less extensive, showed a benefit of IDS: (relative risk) RR = 0.7 (95% confidence interval (CI): 0.5 to 0.9, I2 = 0%). Likewise, substantial heterogeneity between two trials for PFS evaluating 702 women was also shown (I2 =75%). Rates of toxic reactions to chemotherapy were similar in both arms (RR = 1.3, 95%CI: 0.4 to 3.6), but little information is available for other adverse events. Only one trial reported quality of life (QOL), which was generally similar in both treatment arms. Authors' conclusionsNo 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 the patients whose primary surgery was not performed by gynecologic oncologists or was less extensive. Data on QOL and adverse events were inconclusive. |