ABSTRACT
Background: The objective of this study is to evaluate the predictive value of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in advanced epithelial ovarian carcinoma (EOC).Methods: A retrospective hospital-based study of patients with advanced epithelial ovarian cancers (stage III and IV) was conducted at Department of Obstetrics and Gynecology in Gujarat Cancer and Research Institute, Ahmedabad, for two years. Total 50 patients were treated with NACT followed by surgical cytoreduction and followed up till August 2010. Response to NACT, optimal cytoreduction rate and overall response rate were analyzed.CA 125 levels before (baseline) and after NACT were analyzed.Results: Out of 50, there were 43 patients (86%) with stage III disease and 7 (14%) with stage IV disease. Maximum 37(74%) patients had CA 125 levels >500 on presentation while none of the patients had baseline CA125 levels in the normal range (<35). Range of baseline CA 125 was 164-5394.All patients were given NACT and after NACT, out of 50 patients, 22(44%) patients had CA 125 values within the normal range (<35) while 23(46%) had values between 35 and 100. Thus, statistically significant difference (Z = 6.154, P<0.0001) was found between CA 125 level before and after NACT. Out of 45 patients with CA 125 <100, 35(77.8%) underwent optimal cytoreduction.Conclusions: Baseline (prechemotherapy) serum CA-125 levels are powerful indicators of the presence and extent of spread of disease while CA-125 level particularly <100U/ml after NACT strongly predicts optimal cytoreduction in advanced epithelial ovarian cancers.
ABSTRACT
The aim of this study was to assess the efficacy of consolidation therapy with hexamethylmelamine (HMM) in patients with advanced epithelial ovarian cancer (EOC). Patients treated at our hospital between January 1997 and November 2006 and in documented clinical complete response from advanced ovarian cancer following front-line platinum-based therapy were retrospectively analyzed. The patients treated with HMM were compared to the patients of matched counterpart without consolidation therapy. Of 102 patients enrolled, 49 were treated with HMM and 53 received no consolidation treatment. For patients with HMM and observed patients, the mean age were 54.6 and 55.6 yr; the distribution of stage was similar (P=0.977); the optimal surgery was performed in 36 (73.5%) and 44 (83%) (P=0.336); the recurrence rate were 27 (55.1%) and 33 (62.3%) (P=0.463); and the median progression-free survival were 38 months and 21 months for patients with HMM and observed patients (P=0.235). No treatment-related adverse events were reported during the follow-up period. Although this study failed to show the significant survival benefit of consolidation therapy with HMM in patients with advanced EOC, we consider that our study can contribute data to investigate the effectiveness of consolidation therapy in epithelial ovarian cancer.