Neoadjuvant Chemotherapy in Ovarian Cancer

Objective: The primary objective of the study was to compare the efficacy and safety of adjuvant chemotherapy (ACT) with neoadjuvant chemotherapy (NACT) in patients with ovarian epithelial cancer (OEC). Place Duration of Study: This Randomized Controlled Trial was conducted at Shaukat Khanum Memorial Cancer Hospital Research Center, Lahore (Pakistan). Patients were enrolled and treated over one year from August 2008 to July.2009. Patients Methods: Total of 31 patients with advanced ovarian cancer who were selected by consecutive (non probability) sampling were divided into 2 groups to receive platinum-based chemotherapy in either adjuvant (n = 14) or neoadjuvant setting (n = 17). Efficacy was determined using radiological, pathological and biochemical (CA-125) response rates at the completion of treatment. Adverse effects of chemotherapy were noted to assess the safety of therapy. Results: Patients in ACT arm showed superior radiological (92.9% vs. 54.4%, p = 0.039) and pathological (64.3% vs. 11.8%, p = 0.001) response rates as compared to patients in NACT arm. Higher number of patients in ACT arm were able to have optimal cytoreductive surgery than in NACT arm, but this could not reach statistical significance (85.7% vs. 76.4%; p = 0.664), probably due to small study population size. Biochemical response rates were better in NACT group (94.1% vs. 84.7%; p = 0.564). Both hematological and nonhematological adverse effects were higher in women treated with NACT. Conclusion: Use of ACT is more efficacious and safe for patients with ovarian epithelial cancer as compared to NACT.