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Primary versus interval debulking surgery and the risk to induce platinum resitance.

2014; Lippincott Williams & Wilkins; Volume: 32; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2014.32.15_suppl.5588

1527-7755

Alexandre André Balieiro Anastácio da Costa, Camila Vieira Valadares, Augusto Obuti Saito, Adriana Regina G. Ribeiro, Milena Shizue Tariki, Andréa Paiva Gadêlha Guimarães, Solange Moraes Sanches, Celso Abdon Lopes de Mello, Julio Cesar Prestes, Maria Isabel Achatz,

Ovarian cancer diagnosis and treatment

5588 Background: Interval debulking surgery (IDS) is an option to treat patients with stage IIIC and IV ovarian carcinoma. Two randomized trials have shown similar survival for primary debulking sugery (PDS) and IDS. One of the concerns with IDS is the potentialy higher risk to induce platinum resistance when treating patients with larger disease volume. At least one retrospective analysis sugest that patients treated with IDS have a higher risk to develop platinum resistance at second relapse. Methods: We did a retroscpective review of medical records from 213 patients with stage IIIC and IV ovarian carcinoma treated at a single institution from 2000 to 2013. We analysed the association of baseline clinical and pathological characteristics with time to first platinum resistant relapse (TTPR), platinum resitant disease at first relapse, defined as a platinum free interval (PFI) after first line chemotherapy less than 6 months, and overall response rate (ORR) to chemotherapy at first platinum sensitive relapse. Results: For a median follow-up time of 58.6 months, the overall survival was 45.2 months and progression free survival was 18.3 months. Factors related to a shorter TTPR in univariate analysis were residual disease (RD) > 10mm after surgery, CA 125>150 before first treatment (chemotheray or surgery) and IDS compared to PDS. In the multivariate cox regression model including these three variables and age and stage (IIIC vs IV), RD>10mm (HR 1.87, CI95% 1.37-2.44, p 150 (HR 3.39, CI95% 1.31-8.81, p=0.012) and IDS (HR 1.79, CI95% 1.02-3.18, p=0.043) remained associated to a shorter TTPR. The only factor associated to a greater risk of a PFI 10mm (OR 1.59, CI95% 1.14-2.20, p=0.005) and the only factor associated to a worse ORR to chemotherapy at first platinum sensitive relapse was IDS (OR 4.32, CI95% 1.15-16.15, p=0.030. Conclusions: IDS may be associated to a greater risk of platinum resistance induction. Some of the bias in choosing PDS or IDS may not have been accounted in this analysis due to its the retrospective nature, but it supports the hypotesis of other papers and suggests that it would be interesting to see this analysis done in patients from PDS vs IDS clincal trials already published.