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Master Thesis

Prise en charge chirurgicale des cancers de l’ovaire de stade avancé après chimiothérapie néoadjuvante : étude rétrospective comparant la prise en charge chirurgicale après 3 cycles ou plus

Abstract : Introduction – Ovarian cancer is the most lethal gynecologic cancer in developed countries. Survival rates for ovarian cancer have changed modestly for decades, and remain at 45 % 5 years after diagnosis. About 75% of the diagnosis are made at Stage III or IV of the FIGO classification, due to the lack of specific symptoms at the onset of the disease and the absence of effective screening. The standard of care for ovarian cancer has been primary debulking surgery followed by platinum-based chemotherapy. The goal of surgery is the complete resection of all macroscopic disease, which has proved to be the most independent prognostic factor for survival in the management of ovarian cancer. For patients presenting a disease not suitable for primary surgery due to a high tumoral load or a patient in poor condition, an alternative is possible, consisting of an interval surgery after administration of neoadjuvant chemotherapy. This management has been discussed in numerous studies, and has proved to reduce surgical morbidities in case of interval surgery compared to primary surgery.Classically, 3 cycles of chemotherapy are realized. However, the number of cycles and the optimal moment for surgery is still questionable, and there is today no existing consensus. Material and Methods – We conducted a retrospective study, in a referral center, evaluating the management of patients diagnosed with advanced ovarian cancer (FIGO IIIC-IV) beneficiating of interval surgery after neoadjuvant chemotherapy. We compared two groups, one in which patients underwent 3 cycles of chemotherapy before surgery, and a second group in which patients underwent more than 3 cycles. The main objective of this study was to evaluate overall survival and progression-free survival. Secondary objectives regarded surgical morbidity and extent of cytoreduction. Results – 140 patients underwent interval sugery after neoadjuvant chemotherapy. Among these patientes, 45 patients beneficiated of 3 or less cycles (group 1) and 95 patients of more than 3 cycles (group 2). There was no statistical difference for overall and progression free survival. The mean overall survival was 58,4 months for group 1 and 58,3 for group 2 (p.value = 0.56). The mean progression free survival was 30,5 months for group 1 and 23,8 months for group 2. There was no statistical difference between the two groups (p.value = 0,56). Surgical morbidity was lesser in group 2. More posterieur pelvectomies were realized in group 1 (33,3%) compared to group 2 (14,7%) with a statistically significant difference (p=0,01). There were no difference regarding complete macroscopic difference during the surgery between the 2 groups (p=0,09). Conclusion – Debulking surgery is an invasive and heavy procedure and is not always possible in first line due to patient status or to the extent of the disease. Neoadjuvant chemotherapy followed by interval debulking surgery is an accepted alternative for these patients. The number of administered cycles is questionable, and does not seem to have a significant impact on overall survival and progression free survival. However, surgical morbidity is significantly reduced by increased cycles of chemotherapy. The CHRONO study, phase III randomized trial currently recruiting, comparing interval surgery after 3 or 6 cycles should answer this question.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03422435
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Tuesday, November 9, 2021 - 5:24:32 PM
Last modification on : Thursday, November 11, 2021 - 3:34:35 AM

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Maureen Cohen Bacry. Prise en charge chirurgicale des cancers de l’ovaire de stade avancé après chimiothérapie néoadjuvante : étude rétrospective comparant la prise en charge chirurgicale après 3 cycles ou plus. Médecine humaine et pathologie. 2021. ⟨dumas-03422435⟩

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