Ovarian Cancer Treatment: Surgery Must Precede Chemotherapy for Patients with Aggressive Disease

According to World Cancer Research Fund, ovarian cancer is the eighth most common cancer in women and the 18th most commonly occurring cancer overall.

Around 70% of malignant tumors and have the worst prognosis are those with high-grade serious carcinoma (HGSC). In people with ovarian cancer, the most common treatments are surgery and chemotherapy, although there have been debates over which should come first.

A study, entitled "Computational modeling of ovarian cancer dynamics suggests optimal strategies for therapy and screening," published in Proceedings of the National Academy of Sciences, showed that patients with the advanced form of ovarian cancer are more likely to be cured with surgery first and then followed by chemotherapy.

The study used mathematical models to help physicians decide which of the available treatments would work best for patients with HGSC.

Surgery Should Come First to Treat Ovarian Cancer

Researchers at NYU Grossman School of Medicine, Perlmutter Cancer Center, and Dana-Farber Cancer Institute used clinical data from approximately 300 patients in past studies about responses of ovarian cancer patients to primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT).

Their analysis showed that patients who can undergo surgery first and chemotherapy later have a superior outcome to other treatment options, Medical Xpress reported. That means patients would most likely need lesser cycles of chemotherapy to shrink the tumor after surgery.

Moreover, a shorter period of initial chemotherapy rather than the existing recommended interval might provide greater benefit for patients who are not well enough for surgery.

Study first author Shengqing Gu, Ph.D., said that the issue of whether PDS or NACT should be used in treating ovarian cancer was controversial mainly because of the different characteristics of patients in different clinical studies.

So, they built a mathematical model that enabled them to compare treatment outcomes and assess which group of the same virtual patients would have different responses to PDS or NACT.

"Our model, combined with earlier clinical data, suggests that for patients who can undergo complete debulking, surgery offers the best chance of long term survival or even cure," study co-senior author Benjamin G. Neel, MD, Ph.D. said in a news release in PR Newswire. "Our model also provides some insight about optimal early detection and treatment intervals."

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A Guide for Future Studies in Ovarian Cancer Treatment

Study authors believe that their study opens several questions that should be addressed by future randomized clinical trials, the news release reported. This includes assessing the effect of the time gap between having PDS and the subsequent NACT, which could influence treatment outcome.

Additionally, they should be able to examine whether the number of initial chemotherapy is associated with certain outcomes. Lastly, future studies must show whether complete secondary surgery on relapse tumors could improve the prognosis.

Neel thinks that their mathematical model shows that some patients with HSGC could have long-term survival or even cure when they undergo complete debulking and then followed by chemotherapy.

He added that new treatments are needed for those patients who can not undergo complete debulking and for those who have treatment-resistant cancer cells.