A new study shows that some patients with an aggressive form of ovarian cancer are more likely to be cured by surgical removal of their tumor before chemotherapy instead.
Led by researchers at the NYU Grossman School of Medicine, the Perlmutter Cancer Center and the Dana-Farber Cancer Institute, the study used a mathematical tool to examine how doctors should coordinate available treatments for serum ovarian high degree. cancer (HGSC).
Ovarian cancer is the eighth most common cancer and cancer death in women worldwide, and HGSC accounts for approximately 70% of ovarian malignancies and has the worst prognosis. Patients with this disease often suffer surgery i chemotherapy, but there has been a long controversy over the best order of treatment.
Posted online June 14 a Proceedings of the National Academy of Sciences, the new analysis argues that patients who can first undergo “complete debugging” surgery, with chemotherapy added later (called primary splitting surgery or PDS), should have a better outcome than the other main treatment option: giving patients a few cycles of chemotherapy to reduce the tumor before surgery (neoadjuvant chemotherapy or NACT).
“The question of whether PDS or NACT should be used was highly controversial and one of the main reasons lies in the different characteristics of patients in different clinical studies,” says Shengqing Gu, Ph.D., first student, graduate of the University. of Toronto and now an instructor at the Dana-Farber Cancer Institute. “So we built a mathematical model simulate the clinical course of HGSC, which allows us to compare treatment outcomes in the same virtual patients and examine which group of patients may respond differently to PDS vs NACT ”.
“Our model, combined with above clinical data, suggests that for patients who may suffer complete despair, surgery offers the best chance of long-term survival or even cure, “says Benjamin G. Neel, co-senior of the study, MD, Ph.D., director of the Perlmutter Cancer Center at New York University Langone Health. “Our model also provides information on optimal early detection and treatment intervals.”
The researchers used clinical data from nearly 300 patients in previous studies on patient responses to PDS or NACT, extracted from the Princess Margaret Cancer Center in Toronto and the Canadian Cancer Trials Group.
The researchers found that in patients good enough for surgery, debulking provides better results, as it has the best chance of removing chemotherapy-resistant cancer cells. For patients who are too ill for debilitating surgery, the study suggests that a shorter period of initial chemotherapy, rather than the currently recommended interval, may provide a greater benefit.
Current analyzes suggest several questions that future randomized clinical trials should examine, the study authors say. These include the extent to which the influence of the time gap between surgery and subsequent chemotherapy can affect treatment outcomes, whether there is a link between the number of initial cycles of chemotherapy, and the outcomes, and whether complete secondary surgery on a relapsed tumor improves the prognosis.
“Our model shows that a fraction of patients can have long-term survival or even be cured, but only when they undergo a complete devaluation, followed by currently available therapies,” says Neel. “There is an urgent need for new therapies to provide cures to patients for whom it cannot be completely detached and to those who have the most resistant cancer cells to treatment.”
Shengqing Gu et al., “Computational modeling of ovarian cancer dynamics suggests optimal strategies for therapy and screening.” PNAS (2021). www.pnas.org/cgi/doi/10.1073/pnas.2026663118
NYU Langone Health
Citation: The model suggests that surgery should precede chemotherapy for select patients with ovarian cancer (2021, June 14) recovered on June 14, 2021 at https://medicalxpress.com/news/2021-06- surgery-chemotherapy-patients-ovarian-cancer.html
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