DOI QR코드

DOI QR Code

Treatment Outcomes of Epithelial Ovarian Cancers Following Maximum Cytoreduction and Adjuvant Paclitaxel-Carboplatin Chemotherapy: Egyptian NCI Experience

  • Published : 2015.11.04

Abstract

Background: Epithelial ovarian cancer (EOC) is the commonest malignancy involving the ovaries. Maximum surgical cytoreduction (MCR) followed by adjuvant taxane-platinum chemotherapy are the standard of care treatments. Aims: To study treatment outcomes of EOC patients that were maximally cyto-reduced and received adjuvant paclitaxel-carboplatin (PC) chemotherapy. Materials and Methods: This retrospective cohort study included 174 patients with EOC treated at the Egyptian National Cancer Institute between 2006 and 2010. For inclusion, they should have had undergone MCR with no-gross residual followed by adjuvant PC chemotherapy. MCR was total abdominal hysterectomy/bilateral salpingo-oophorectomy [TAH/BSO] or unilateral salpingo-oophorectomy [USO] plus comprehensive staging. Results: The median age was 50 years. Most patients were married (97.1%), had offspring (92.5%), were postmenopausal (53.4%), presented with abdominal/pelvic pain and swelling (93.7%), had tumors involving both ovaries (45.4%) without extra-ovarian extension i.e. stage I (55.2%) of serous histology (79.9%) and grade II (87.4%). TAH/BSO was performed in 97.7% of cases. A total of 1,014 PC chemotherapy cycles were administered and were generally tolerable with 93.7% completing 6 cycles. Alopecia and numbness were the commonest adverse events. The median follow up period was 42 months. The 2-year rates for disease free survival (DFS) and overall survival (OS) were 70.7% and 94.8%, respectively. The respective 5-year rates were 52.6% and 81.3%. Advanced stage and high-grade were significantly associated with poor DFS and OS (p<0.001). Age >65 years was associated with poor OS (p =0.008). Using Cox-regression, stage was independent predictor of poor DFS and OS. Age was an independent predictor of poor OS.

Keywords

References

  1. Abd el-bar I (2007). Cancer in egypt, gharbiah. triennial report of 2000-2002, Gharbiah population based cancer registry. 1st ed.; ISBN, 977-17-4932-3.
  2. Alieldin N (2014). NCI Hospital based registry 2002-2010 [online].
  3. Alsop K, Fereday S, Meldrum C, et al (2012). BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer, are ports from the australian ovarian cancer study group. J Clin Oncol, 30, 2654-63. https://doi.org/10.1200/JCO.2011.39.8545
  4. Bamias A, Papaddimitriou C, Efstathiou E, et al (2006). Four cycles of paclitaxel and carboplatin as adjuvant treatment in early-stage ovarian cancer, a six-year experience of the Hellenic Cooperative Oncology Group.BMC Cancer, 6, 228. https://doi.org/10.1186/1471-2407-6-228
  5. Beth YK, Maurie AM, Patricia JE (2005). Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma, in DeVita VT, Hellman S, Rosenberg SA (eds), Cancer, principles and practice of oncology. Philadelphia, PA, Lippincott Williams & Wilkins.
  6. Chan J, Fuh K, Shin J, Cheung M, Powell C, et al (2008). The treatment and outcomes of early-stage epithelial ovarian cancer, have we made any progress? Br J Cancer, 98, 1191-6. https://doi.org/10.1038/sj.bjc.6604299
  7. Collinson F, QianW, Fossati R, et al (2014). Optimal treatment of early-stage ovarian cancer. Ann Oncol, 25, 1165-71. https://doi.org/10.1093/annonc/mdu116
  8. Colombo N, Guthrie D, Chiari S, et al (2003). International collaborative ovarian neoplasm trial 1, a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. J Natl Cancer Inst, 95, 125-32. https://doi.org/10.1093/jnci/95.2.125
  9. Domanska K, Malander S, Masback A, Nilbert M (2007). Ovarian cancer at young age, the contribution of mismatchrepair defects in a population-based series of epithelial ovarian cancer before age 40. Int J Gynecol Cancer, 17, 789-93. https://doi.org/10.1111/j.1525-1438.2007.00875.x
  10. El-Attar I (2005). Cancer in Arab world, magnitude of the problem UICC, 35-36.
  11. Elit L, Chambers A , Fyles A, et al (2004). Systematic review of adjuvant cares for women with Stage I ovarian carcinoma. Cancer, 101, 1926-35. https://doi.org/10.1002/cncr.20595
  12. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide, IARC Cancer Base No. 11 [Internet]. Lyon, France, International Agency for Research on Cancer
  13. Fleming GF, Filiaci VL, Bentley RC (2009). Epithelial ovarian cancer. In RR barakat et al., eds., principles and practice of gynecologic oncology, 5th ed., pp. 763-835. Philadelphia, Lippincott Williams and Wilkins.
  14. Fourati A, Louchez MM, Fournier J, et al (2014). Screening for common mutations in BRCA1 and BRCA2 genes, interest in genetic testing of Tunisian families with breast and/or ovarian cancer. Bull Cancer, 101, 36-40.
  15. Freedman LS, Al-Kayed S, Qasem MB, et al (2001). Cancer registration in the middle east. Epidemiol, 131-3.
  16. Garcia M, Jemal A, Ward EM, et al (2007). Global cancer facts & figures. Atlanta GA, American Cancer Society.
  17. Heintz AP, Odicino F, Maisonneuve P, et al (2006). Carcinoma of the ovary. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet, 95, 161-92. https://doi.org/10.1016/j.ijgo.2006.05.005
  18. Malik IA (2002). A prospective study of clinico-pathological features of epithelial ovarian cancer in Pakistan. J Pak Med Assoc, 52, 155-8.
  19. Mohamed FM, Nour E, Noha A (2012). Retrospective analysis evaluating ovarian cancer cases presented at the clinical oncology department, alexandria university faculty of medicine. Alexandria J Med, 48, 353-60. https://doi.org/10.1016/j.ajme.2012.07.001
  20. Mokhtar N, Gouda I, Adel I (2007). Cancer pathology registry 2003-2004and time trend analysis. Chapter 1; Table 1.4 ranking of some important malignant tumor, pathology department NCI.
  21. Paes MF, Daltoe RD, Madeira KP, et al (2011). A retrospective analysis of clinicopathologiocal and prognostic characteristics of ovarian tumors in the state espritio santo. Braz J Ovarian Res, 9, 4-14.
  22. Piek JM, Van Diest PJ, Verheijen RH, et al (2008). Ovarian Carcinogenesis, an alternative hypothesis. Adv Exp Med Biol, 622, 79-87. https://doi.org/10.1007/978-0-387-68969-2_7
  23. Saeed S, Akram M (2012). Epithelial ovarian cancer. epidemiology and clinicopathological features. Prof Med J, 19, 040-5.
  24. Sarwar CM, Siddiqui N, Khokhar RA, Badar F, et al (2006). Epithelial ovarian cancer at a cancer hospital in a developing country. Asian Pac J Cancer Prev, 7, 595-8.
  25. Sehouli J, Savvatis K, Braicu E, et al (2010). Primary versus interval debulking surgery in advanced ovarian cancer, Results from a systematic single-center analysis. Int J Gynecol Cancer, 20, 1331-40.
  26. Siegel R, Ma J, Zou Z, Jemal A (2014). Cancer statistics. CA Cancer J Clin, 64, 9-29. https://doi.org/10.3322/caac.21208
  27. Singh P, Arunachalam I, Singh P, et al (1990). Ovarian cancer in oriental women from singapore, disease pattern and survival. Int Surg, 75, 115-22.
  28. Thrall MM, Gray HJ, Symons RG, et al (2011). Trends in treatment of advanced epithelial ovarian cancer in the Medicare population. Gynecol Oncol, 122, 100-6. https://doi.org/10.1016/j.ygyno.2011.03.022
  29. Trimbos JB, Parmar M, Vergote I, et al (2003), Two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. european organization for research and treatment of cancer collaborators-adjuvant chemotherapy UN ovarian neoplasm. J Natl Cancer Inst, 95, 105-12. https://doi.org/10.1093/jnci/95.2.105
  30. Trimbos JB, Vergote I, Bolis G, et al (2003). Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma, european organisation for research and treatment of cancer adjuvant chemotherapy in ovarian neoplasm. J Natl Cancer Inst, 95, 113-25. https://doi.org/10.1093/jnci/95.2.113
  31. Trimbos B, Timmers P, Pecorelli S, et al (2010). Surgical staging and treatment of early ovarian cancer, long-term analysis from a randomized trial. J Natl Cancer Inst, 102, 982-87. https://doi.org/10.1093/jnci/djq149
  32. Vergote IB, Trope CG, Amant F, et al (2010). Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med, 363, 943-53. https://doi.org/10.1056/NEJMoa0908806
  33. Winter-Roach BA, Kitchener HC, Dickinson HO, et al (2012). Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer. Cochrane Database Syst Rev, 4706
  34. Wong AS, Auersperg N (2003). Ovarian surface epithelium, family history and early events in ovarian cancer. Reprod Biol Endocrinol, 1, 70. https://doi.org/10.1186/1477-7827-1-70
  35. Zeeneldin AA, Ramadan M, Gaber AA, et al (2013). Clinicopathological features of breast carcinoma in elderly Egyptian patients, a comparison with the non-elderly using populationbased data. J Egypt Natl Canc Inst, 25, 5-11. https://doi.org/10.1016/j.jnci.2012.10.003