Response evaluation of locally advanced carcinoma ovary to neoadjuvant chemotherapy at a tertiary care centre

ABSTRACT

Background: Clear cell and mucinous types of epithelial ovarian cancers are relatively chemo resistant and have a poorer prognosis compared to other histologies. Aim of the study was to study the biochemical and histopathological response and surgical outcome of various histologies to standard platin based chemotherapy.Methods: All 42 cases of locally advanced carcinoma ovary who received several cycles of neoadjuvant chemotherapy (NACT) followed by, interval cytoreductive surgery (ICS) were included in this study. Serum CA125 levels before and after neoadjuvant chemotherapy, the ability to achieve optimal cytoreduction and the presence of residual tumour in the surgical specimen were the parameters measured. Continuous variables were compared by one-way ANOVA. Categorical variables were compared by the Pearson chi-square test. Significance was defined by p values less than 0.05. Survival analysis was done using Kaplan-Meier estimation.Results: There was a 95,84% reduction in serum CA125 levels for papillary serous carcinoma compared to clear cell and mucinous varieties, which had 81.2% and 78.5% reduction, respectively. More number of papillary serous tumours were able to achieve optimal cytoreduction (72%) compared to mucinous variety (25%). Residual tumour was present in 68% of serous papillary tumours compared to 87.5% in mucinous and 80% in clear cell histology.Conclusions: Our study concludes that mucinous and clear cell types of EOC are relatively chemo resistant compared to the serous subtype. We recommend more aggressive surgery especially for mucinous tumours. In the case of ovarian cancer, we observed that the mucinous and clear cell types of EOC are relatively chemoresistant compared to the serous subtype. From the results, we recommend the more aggressive strategy of surgery as a preliminary choice of treatment especially for mucinous tumours rather than chemotherapy in patients with EOC.