Epitelyal Over Kanserinde Neoadjuvan Kemoterapinin Tümör Yayılımı Üzerine Etkisi

Abstract

ABSTRACT Aim: Ovarian cancer is the third most common gynecologic malignancy and the most common cause of death from gynecologic cancer in the world. The majority of ovarian malignancies (90%) originates from epithelial cells. Unfortunately, there is no effective screening test to ensure that diagnoses of this malignancy at an early stage. Patients diagnosed with ovarian malignancy usually have advanced disease. Primary treatment for ovarian cancer is surgical cytoreduction, but surgical treatment may not be always possible. Low performance status of the patient due to older age and advanced stage disease at the time of diagnosis sometimes may make complete surgical cytoreduction impossible. Patients that are not suitable for surgery due to the location and volume of the disease or medical comorbidities can be considered for neoadjuvant chemotheraphy (NACT). Studies in the literature are mostly on surgical and survival outcomes of patients that were treated with NACT. In our study, we evaluate the location of tumor spread after NACT. Material and Method: This study was carried out retrospectively on the records of the patients that were treated at Hacettepe University Department of Gynecology and Obstetrics, Gynecological Oncology Unit for epithelial ovarian cancer between 2009 and 2017. Patients that underwent a complete surgical cytoreduction after NACT and whose definitive pathological diagnosis was epithelial ovarian cancer were included in the study. A total of 36 patients with epithelial ovarian cancer who met these criteria were evaluated. Results: When compared with the control group, CA 125 levels were significantly higher at the time of diagnosis in the NACT group. After NACT, CA 125 levels were significantly lower than in the control group. At the time of diagnosis in the NACT group, the median value for CA 125 was found to be 1,387 U/ml. After NACT administration, the median value for CA 125 was found 33.5 U/ml. The median value for CA 125 in the control group was 301.5 U/ml at the time of diagnosis. The difference was statistically significant. (p˂0,001) xiii In the NACT group, ovarian involvement was 55.6% at the time of cytoreduction, whereas it was 92.5% in the control group. The difference was statistically significant. (p˂0,001) The rate of metastases to the omentum, peritoneum and retroperitoneal lymph nodes was similar between the two groups. Conclusion: These results show that chemotherapy reaches effective therapeutic dose where the blood supply is good. Therefore, the response to NACT in these areas was better. Large tumoral masses and the areas with poor blood supply will not be adequately treated with NACT. Identifying the factors that determine the efficacy of chemotherapy in future studies, would lead to a longer survival and a better quality of life for women with ovarian cancer.