Evaluation of Optimal Number of Neoadjuvant Chemotherapy Cycles and Cytoreductive Surgery in Women with Ovarian Cancer

Despite the increasing trend in using neoadjuvant chemotherapy (NACT) in advanced ovarian cancer (OC), there is still no consensus on the optimal number of NACT cycles before interval debulking surgery (IDS). We aimed to investigate the differences in outcomes of patients with OC undergoing ≤ 3 and ≥ 4 courses of NACT in Iran.

In a retrospective cohort study, we compared subjects with stage III or IV OC who were treated using NACT followed by IDS. We compared overall survival (OS), disease-free survival (DFS), optimal surgical outcome, treatment response (composite of CA-125 response and radiological response) between those receiving ≤ 3 and ≥ 4 courses of NACT. We used Kaplan–Meier and Log-rank tests to compare survival between the groups.

107 subjects with a mean age of 55.41 ± 11.44 years were included in the final analysis 48 (44.9%) of whom had received ≥ 4 courses of chemotherapy. Participants with a complete treatment response had a lower average of NACT courses compared to those with a partial treatment response (1.83 ± 1.47 vs. 3.90 ± 1.32; p < 0.01). 76.8 and 59.6% of subjects had an optimal surgery in groups with ≤ 3 and ≥ 4 NACT courses, respectively (p = 0.06). There were no significant differences in months of OS (41.66 vs. 33.96; p = 0.31) or DFS (26.71 vs. 19.85; p = 0.46) between those receiving ≤ 3 and ≥ 4 cycles of NACT, respectively.

Overall, women treated with ≤ 3 and ≥ 4 NACT courses have no significant differences in terms of OS, DFS or optimal IDS results. It is imperative to focus on developing clear guidelines to enhance early diagnosis, patient selection and optimal chemotherapeutic and surgical interventions.