The Effect of the Interval from the Third Cycle of Neoadjuvant Chemotherapy to Interval Debulking Surgery on the Surgical Results in Advanced Epithelial Ovarian Cancer

Background Ovarian cancer is the leading cause of death among all gynecological malignancies in developed countries. Eighty to ninety percent of ovarian cancers are epithelial, and more than two-thirds are diagnosed at an advanced stage. The current standard of management for a patient with advanced (stage III or IV) ovarian cancer is cytoreductive surgery followed by administration of systemic chemotherapy. Recently, the efficiency of "neoadjuvant chemotherapy" in ovarian cancer treatment has been widely discussed. Patients and Methods This was a retrospective study. Thirty patients (n = 30) were treated by (CP regimen: carboplatin and paclitaxel) as neoadjuvant combination chemotherapy then followed by cytoreductive surgery (interval debulking surgery). These patients were divided into two equal groups according to surgery interval, 15 patients each, as regards the timing of IDS; Group A: Patients who underwent IDS within 42 days from last cycle of chemotherapy. Group B: Patients who underwent IDS after 42 days from last cycle of chemotherapy. Then evaluation of optimum cytoreduction was done. Results Optimum cytoreduction was achieved in 15 patients in Group I (100 % of cases of Group I), and this shows statistically significant differences between Group I and Group II where P = 0.0012. Optimum cytoreduction was achieved in three patients in Group II (20 % of cases of Group II). Suboptimal cytoreduction was achieved in 12 patients of Group II only (75 % of cases of Group II) with residual disease; mainly in pelvis, abdominal surface of diaphragm and liver surface. Conclusion "Neoadjuvant chemotherapy" considers an alternative method for inoperable cases to be operable cases. The optimal timing for standard cytoreduction surgery was within 42 days of last NAC cycle, we found that longer interval between neoadjuvant chemotherapy and interval debulking surgery (IDS) have an adverse effect on survival.