Title: Is randomized trial of neoadjuvant chemotherapy of ovarian cancer necessary?
Abstract: I have read the interesting paper of Onda et al. [ [1] Onda T Kobayashi H Nakanishi T Hatae M Iwasaka T Konishi I Shibata T Fukuda H Kamura T Yoshikawa H. Japan Clinical Oncology Group Study JCOG0206Feasibility study of neoadjuvant chemotherapy followed by interval debulking surgery for stage III/IV ovarian, tubal, and peritoneal cancers. Gynecol Oncol. 2009 Jan 30; ([Electronic publication ahead of print]) Google Scholar ] in the January issue. There is a well concerted effort to see the efficacy of neoadjuvant chemotherapy in advanced ovarian cancer by large randomized trials. Two of them are EORTC protocol 55971 and Japan Clinical Oncology Group Study JCOG0602. With the high response rate of carboplatin-paclitaxel, benefit of neoadjuvant chemotherapy must be reaching a higher number of sufferers now. I have noticed an interesting finding of Schwartz (2008) [ [2] Schwartz P.E. What is the role of neoadjuvant chemotherapy in the management of ovarian cancer?. Oncology (Williston Park). 2008 Sep; 22 (discussion 1130, 1132, 1134): 1118-1125 PubMed Google Scholar ] which I think is very correct. If 23% of stage III and 8% of stage IV are amenable to satisfactory cytoreduction ( [2] Schwartz P.E. What is the role of neoadjuvant chemotherapy in the management of ovarian cancer?. Oncology (Williston Park). 2008 Sep; 22 (discussion 1130, 1132, 1134): 1118-1125 PubMed Google Scholar ) and anecdotal about 70% ovarian cancer is in the advanced stage how come primary cytoreduction can compete with neoadjuvant chemotherapy as is done in RCTs. This is because a number of patients get fully treated in the neoadjuvant arm and is clearly much above those in the primary cytoreduction arm in practice. How can they be compared? Universality of neoadjuvant arm due to 90% response rate of carbo-pacli should negate any such competition and comparison. A much greater number of such ovarian cancers must be treated now. At least my experience is like this. Many more women must be living for many more years. The total sum of life year saved by neoadjuvant is important now and need be calculated.
Publication Year: 2009
Publication Date: 2009-08-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 1
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