Over Kanseri Yönetiminde Kliniko-Patolojik Sonuçlar: Hacettepe Üniversitesi Deneyimleri

Abstract

Zaim, OC, Clinicopathological Outcomes of Ovarian Cancer Management: Hacettepe University Experience, Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology Residency Thesis, Ankara 2022. High grade serous carcinomas are the most common histopathological subtype of ovarian cancer. Mostly the patients diagnosed with advanced stage disease and this condition complicates the management of the disease. The main approach to management of disease consists of primary surgery and adjuvant chemotherapy regimens. However, some patients cannot be good candidates for primary surgery and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) emerges as an alternative management strategy. There are quite lot trials that indicates this strategy can be as effective as the main approach. In our study, it was aimed to show that both strategies applied in our clinic are similar in terms of effectiveness. Our study retrospectively included 151 patients who were treated between January 2014 and May 2021 in Hacettepe University Faculty of Medicine, Gynecological Oncology Clinic with a diagnosis of advanced stage high-grade serous carcinoma according to FIGO 2014 staging. These patients were divided into two groups by their strategies as 77 patients for primary debulking surgery (PDS) and 74 patients for NACT/IDS in terms of 1:1 ratio. These two groups were comparatively investigated for patient characteristics, staging, chemotherapy responses, recurrence, survival periods and follow up outcomes. At the end of the study, the importance of performance status and the clinical stage of patients were found regarding to patient selection for the appropriate strategy. Moreover, direct effect “no residual tumor after surgery” on overall survival rates was determined by multivariate analysis. In terms of recurrence and survival rates it was shown that both of strategies were similar for effectiveness. Impact of COVID-19 pandemic on selection of strategy has also been investigated. In conclusion, if it is envisaged that no residual disease after surgery with appropriate patient selection for strategy, PDS can be considered as leading option.

Keywords: Ovarian cancer, Neoadjuvant therapy, Gynecologic surgical procedures