[09/04, 07:21]: Neoadjuvant chemotherapy prior to cytoreductive surgery is a treatment option in selected patients with advanced EOC. Clinical, routine serial CA-125 assessments and CT serve as the mainstay for response assessment during this therapy. CT is usually performed as a baseline study and after 3 cycles of chemotherapy to determine eligibility for cytoreductive surgery. Alternatively, in insufficient response, medical treatment is continued.
[09/04, 07:29]: Question for oncology practitioners or enthusiasts:
How common is it to start neoadjuvant chemotherapy without any tissue diagnosis but solely depend on CT staging and tumor markers for apparently advanced (on the basis of CT and tumor markers) epithelial ovarian carcinoma?
[09/04, 07:31] : The methodology of the original trial recommending neoadjuvant chemotherapy in similar situations suggests that they recruited:
"Eligible patients who had biopsy-proven stage IIIC or IV invasive epithelial ovarian carcinoma, primary peritoneal carcinoma, or fallopian-tube carcinoma. If a biopsy specimen was not available, a fine-needle aspirate showing an adenocarcinoma was acceptable under the following conditions: the presence of a pelvic (ovarian) mass."
Have the recommendations changed after that and is a tissue diagnosis not necessary?
[09/04, 08:04] : After that 2010 nejm landmark RCT there's been multiple reviews and re-evaluations of the neoadjuvant chemotherapy NACT approach and the problems pointed out are inability to visualise and assess the tumor and it's spread properly during interval debulking but again I couldn't find if NACT was common without a tissue diagnosis but just based on CT imaging and peripheral blood tumor markers alone
[09/04, 08:17] : A recent 2025 Cochrane review may dampen the enthusiasm for NACT as it shows there is likely little or no difference in primary survival outcomes between primary cytoreductive surgery (PCRS ) and NACT for those with advanced EOC who are suitable for either treatment option. NACT reduces the risk of postoperative mortality and likely reduces the risk of serious adverse events, especially those around the time of (PCRS) surgery, and the need for stoma formation. https://pubmed.ncbi.nlm.nih.gov/39927569/
[09/04, 08:44]: Bottom-line for TLDR people:
Although my original question remains unanswered with one center study coming remotely close to answering it, with "Between 1994 and 2007, 149 patients were identified. Initial diagnosis was made on the basis of: cytology (paracentesis, thoracentesis, or fine needle aspirate) 72% (108 patients); histology (core biopsy, surgery) 18% (26), clinical (Radiology and CA-125) 10% (15). The final diagnosis was consistent with invasive EOC in 96% of patients. The diagnostic accuracies of the 3 strategies were: cytology 98%, histology 92%, and clinical 87%, (p=0.04). https://pubmed.ncbi.nlm.nih.gov/20591472/ ,
the above suggesting that 2 patients out of 15 given NACT with just tumor markers and CT imaging could have had an inaccurate diagnosis and given the overall low survival rate of both PCRS and NACT, I am now wondering (perhaps like Steve Jobs) about how much worse or better could it be if we did none of these (NACT or PCRS) and simply resorted to palliative therapy in advanced EOC?
Now can we find any comparative studies with palliative care (doing nothing other than symptomatic relief) vs the usual PCRS and NACT care that appears to be the current usual care?
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