Abstract:
Objective Optimal cytoreductive surgery (CRS), followed by adjuvant chemotherapy, is an important predictor of survival outcome in patients with advanced primary epithelial ovarian carcinoma (EOC). However, the relationship between the time of initiation of adjuvant chemotherapy and prognosis has not yet been clearly defined in EOC. Methods: 185 patients with primary advanced EOC underwent optimal CRS with or without intraperitoneal (IP) chemotherapy and adjuvant chemotherapy. The interval between the day of surgery and start of adjuvant chemotherapy and its impact on outcome was analyzed.
Results CRS, CRS with intraperitoneal chemotherapy as IP port or hyperthermic intraperitoneal chemotherapy (HIPEC) was done in 50, 60 and 75 patients respectively. Overall median interval of starting adjuvant chemotherapy was 32 days in the CRS group, 34 days in CRS+IP group and 41 days in CRS+HIPEC group. Delay in chemotherapy, as more than 42 days interval had a significant impact on RFS in CRS group (36 vs. 17 months; P=0.02). Whereas it had some impact in CRS+IP group (38 vs. 28 months; P=0.78) and no impact on CRS+HIPEC group (35 vs. 32 months; P=0.17). There was trend towards better OS (88 vs. 71 months; P=0.49) when adjuvant chemotherapy was not delayed.
Conclusions Delay in starting adjuvant chemotherapy adversely affected RFS in patients undergoing optimal CRS alone. However, when compared to non-HIPEC group, the delay didn’t have an impact in the HIPEC group owing to the fact that a single dose of chemotherapy during surgery in heated environment may compensate for the delay.
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