TY - JOUR
T1 - Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States
AU - Melamed, Alexander
AU - Hinchcliff, Emily M.
AU - Clemmer, Joel T.
AU - Bregar, Amy J.
AU - Uppal, Shitanshu
AU - Bostock, Ian
AU - Schorge, John O.
AU - del Carmen, Marcela G.
AU - Rauh-Hain, J. Alejandro
N1 - Funding Information:
This work is supported by grant R25CA092203 from the National Cancer Institute at the National Institutes of Health , and the Deborah Kelly Center for Outcomes Research at Massachusetts General Hospital . This study was presented at the Society for Gynecologic Oncology's Annual Meeting on Women's Cancer, San Diego, CA, March 19–22, 2016.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. Methods We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. Results We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 (p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p = 0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% (p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% (p < 0.001). Conclusion Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States.
AB - Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. Methods We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. Results We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 (p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p = 0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% (p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% (p < 0.001). Conclusion Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States.
KW - Advanced ovarian cancer
KW - Neoadjuvant chemotherapy
KW - Temporal trends
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U2 - 10.1016/j.ygyno.2016.09.002
DO - 10.1016/j.ygyno.2016.09.002
M3 - Article
C2 - 27612977
AN - SCOPUS:84995467668
SN - 0090-8258
VL - 143
SP - 236
EP - 240
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 2
ER -
