Oncological Outcomes in Patients with Delayed Cytoreductive Surgery During COVID Times.

Abstract

ESMO ESGO guidelines recommend standard 3-4 cycles of neoadjuvant chemotherapy (NACT) for advanced epithelial ovarian cancers (EOC); however, the ideal number of cycles is still debatable. Literature regarding survival after 5 or more cycles is conflicting. COVID pandemic saw several oncosurgeries postponed due to healthcare crises. The present study was undertaken to evaluate oncological outcomes in patients undergoing delayed cytoreductive surgery (CRS) in advanced Epithelial Ovarian Cancer. This was a hospital-based, retrospective, observational study done at tertiary cancer institute. Objectives were to evaluate progression free survival (PFS) and overall survival (OS) according to timing of surgery and to identify prognostic factors for OS and PFS. The study group included patients undergoing delayed CRS (defined as CRS done after more than 5 cycles of NACT), and the control group is comprised of CRS done after 3-4 cycles NACT. A total of 29 patients underwent delayed CRS. Of these, 58% (n = 17) patients had COVID-related causes for delay in surgery. On comparing with the control group (n = 98), the study group had lower rates of complete cytoreduction (50% vs 71%, p = 0.012). Similarly complete chemotherapy response score was observed in lower proportion of delayed CRS (24.13% vs 28.15%, p = 0.003). Mean CA 125 levels were 89.32 and 148.45 in cases and controls respectively (p = 0.090). PFS of the patients with delayed CRS (7 months) versus the interval CRS group (16 months) showed a statistically significant difference between the two group (p = 0.0001). Also, the OS for the control group was longer (55 months) than cases (34 months) (p ≤ 0.0001). Administration of additional cycles of chemotherapy beyond 3-4 cycles seemed to decrease survival in Ovarian Cancer patients. This approach however, may be beneficial in increasing the survival of patients who are deemed inoperable after 3-4 cycles of chemotherapy.