Neoadjuvant chemotherapy in advanced stage ovarian cancer

Abstract

Background: Primary debulking surgery followed by platinum based chemotherapy was the standard therapy for advanced stage of ovarian cancer in the past. Primary debulking could be performed only in 30 to 60% of the patients with advanced ovarian cancer. In patients who had massive ascites, pleural effusion and large abdominal tumor, hence optimal primary debulking with gross residual disease less than 1 cm was difficult without Neoadjuvant chemotherapy (NACT). Hence present day guidelines suggest to give 3 – 4 cycles of Neoadjuvant chemotherapy to downstage the disease, which eventually helps the surgeon in obtaining optimal cytoreduction, which may transform into a prolonged disease free and overall survival.Aim:1.To study the radiological response of advanced ovarian cancer by RECIST (Response Evaluation Criteria In Solid Tumors) criteria using CT scan2.To Evaluate the correlation of CA 125, pre NACT an post NACT.3.To study the chemotherapy related changes in histopathological evaluation.Materials and Methods: Patients diagnosed as Ca ovary stage III and IV underwent CT imaging and serum CA-125 estimation before and after NACT followed by interval debulking and adjuvant chemotherapy, Response to the Neoadjuvant chemotherapy will be analysed by RECIST criteria. During surgery intra op tumor size is observed and also presence of non- target lesions and documented. The specimen is then sent for histopathological examination to look for chemotherapy related changes. Results: The study was conducted on 34 patients of whom 31 patients had partial response, 1 patient had stable disease and 2 patient had progressive disease after NACT. CA-125 was estimated in these patients prior and after NACT and was found to have reduction in the values which was statistically significant of p value of