SGO Annual Meeting on Women's Cancer 2011

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

"Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer," Dr. Jose Alejandro Rauh-Hain said at the annual meeting of the Society of Gynecologic Oncologists.

Dr. Rauh-Hain and his associates assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only.

Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis. All women received primary therapy from Jan. 1, 1995, to Dec. 31, 2007, at either of the two institutions.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

"It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce," said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts (P = .1).

The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking (P less than .001).

Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that "only 7.5% of these patients who underwent primary debulking had no residual disease." This success rate is similar to 8% of 360 women debulked to no residual disease in another report ( J. Clin. Oncol. 2008;26:83-9).

Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

Dr. Rauh-Hain and his associates also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months.

The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said.

The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery, compared with eight women (5%) of the primary debulking surgery group.

Possible limitations were the retrospective design of the study; lack of information regarding previous or subsequent care at nonaffiliated institutions; and a lack of standardized treatment were possible limitations, Dr. Rauh-Hain said. A lower postoperative mortality rate in the NACT-IDS group suggests there could be selection bias in terms of treatment selection, he added.

Dr. Rauh-Hain said that he had no relevant disclosures. Dr. Rose said he is a member of the Lilly speakers bureau.

ORLANDO – Improper surgery, a lack of lymph node assessment, and improper or no chemotherapy top the list of reasons that women with ovarian cancer do not receive care consistent with National Comprehensive Cancer Network guidelines, according to a study of nearly 100,000 patients.

"Overall, we were quite sad to see that only 43% of patients appear to be receiving care adherent with the NCCN guidelines," Dr. Matthew A. Powell said at this year’s annual meeting of the Society of Gynecologic Oncologists (SGO). "The reasons for nonadherence were mostly surgical in nature."

Dr. Matthew A. Powell

Researchers assessed treatment of 96,802 women diagnosed with invasive epithelial ovarian cancer in the National Cancer Database from 1998 to 2007. They also evaluated mature 5-year survival data from 1998 to 2002.

To determine guideline adherence, Dr. Powell and his associates noted initial surgical procedure and initial front-line chemotherapy. They also assessed compliance by cancer stage, substage, and grade.

The primary reason for nonadherence was a lack of documented omentectomy (54,939 or 57% of the nonadherent cases). "In those patients who did have an omentectomy and stage I to IIIb cancer, we required them to have lymph node assessment," Dr. Powell said. "Unfortunately this also represented a large portion of the nonadherence."

Improper chemotherapy comprised the remainder of nonadherent cases, where patients received single-agent chemotherapy, no chemotherapy, or inappropriate chemotherapy based on cancer stage and grade.

Patients who underwent surgery only (with no evidence of chemotherapy in their records) included a large portion with stage IIIc and IV disease, Dr. Powell said. Only 8% of this cohort received care consistent with the National Comprehensive Cancer Network (NCCN) guidelines.

"One-third of patients had two or three reasons to be nonadherent to the guidelines," said Dr. Powell, who is on the obstetrics and gynecology faculty, Division of Gynecologic Oncology at the Washington University, St. Louis.

The NCCN established the ovarian cancer guidelines in 1997, and they underwent regular revisions, including major updates in 2000 and 2006, Dr. Powell said.

One aim of the study was to determine the validity of NCCN ovarian cancer clinical practice guidelines using a survival comparison. Adherence to the guidelines "does seem to correlate with improved survival and, perhaps, with better quality care. It translates to approximately a 13-month improved median survival for patients who were compliant," Dr. Powell said, adding this difference was "highly statistically significant" (hazard ratio, 1.44).

Adherence and survival correlated across each stage of cancer as well, Dr. Powell said.

During a Q & A session, Dr. Barbara Goff pointed out that some noncompliant care was delivered to patients at one of the 21 major institutions that form the NCCN. "I was surprised that only about 50%-55% of the time were patients at NCCN institutions receiving guideline-based therapy," said Dr. Goff, professor of gynecologic oncology at the University of Washington, Seattle.

"We were quite surprised adherence was that low at centers that write the guidelines," Dr. Powell responded. A higher percentage of referred patients, a lack of information on patients who intentionally decline treatment, and/or less-than-ideal documentation in the database could be contributing factors, he said. "This is obviously a focus for future research."

Patient, tumor, and treatment characteristics were considered in the 5-year survival analysis. "As we all would guess, stage was predictive, with advancing stage [associated] with worse survival," Dr. Powell said. Patients with higher grade cancers also fared worse.

Dr. Powell and his associates also assessed their data according to center volume. For example, in the lowest volume centers (with one to six cases per year), adherence was 40% and median survival was 31 months. At the highest volume centers (with 26 or more cases per year), adherence was 55% and median survival increased to 46 months.

Asked if factors such as increasing age and comorbidity could result in nonadherent, yet appropriate care, Dr. Powell responded. "It’s clear patients with more comorbidities tend to not have NCCN-compliant care." He added, "We want to set a bar and evaluate based on that bar, but it doesn’t mean there cannot be exceptions, patient factors and others.

"We need to measure what we are doing before we can improve," Dr. Powell said. The Society of Gynecologic Oncologists just created a Quality and Data Outcomes Committee designed to assess and measure quality of care as physician performance comes under increased reimbursement pressure in the next few years.

Dr. Powell said he had no relevant disclosures.

ORLANDO – Improper surgery, a lack of lymph node assessment, and improper or no chemotherapy top the list of reasons that women with ovarian cancer do not receive care consistent with National Comprehensive Cancer Network guidelines, according to a study of nearly 100,000 patients.

"Overall, we were quite sad to see that only 43% of patients appear to be receiving care adherent with the NCCN guidelines," Dr. Matthew A. Powell said at this year’s annual meeting of the Society of Gynecologic Oncologists (SGO). "The reasons for nonadherence were mostly surgical in nature."

Dr. Matthew A. Powell

Researchers assessed treatment of 96,802 women diagnosed with invasive epithelial ovarian cancer in the National Cancer Database from 1998 to 2007. They also evaluated mature 5-year survival data from 1998 to 2002.

To determine guideline adherence, Dr. Powell and his associates noted initial surgical procedure and initial front-line chemotherapy. They also assessed compliance by cancer stage, substage, and grade.

The primary reason for nonadherence was a lack of documented omentectomy (54,939 or 57% of the nonadherent cases). "In those patients who did have an omentectomy and stage I to IIIb cancer, we required them to have lymph node assessment," Dr. Powell said. "Unfortunately this also represented a large portion of the nonadherence."

Improper chemotherapy comprised the remainder of nonadherent cases, where patients received single-agent chemotherapy, no chemotherapy, or inappropriate chemotherapy based on cancer stage and grade.

Patients who underwent surgery only (with no evidence of chemotherapy in their records) included a large portion with stage IIIc and IV disease, Dr. Powell said. Only 8% of this cohort received care consistent with the National Comprehensive Cancer Network (NCCN) guidelines.

"One-third of patients had two or three reasons to be nonadherent to the guidelines," said Dr. Powell, who is on the obstetrics and gynecology faculty, Division of Gynecologic Oncology at the Washington University, St. Louis.

The NCCN established the ovarian cancer guidelines in 1997, and they underwent regular revisions, including major updates in 2000 and 2006, Dr. Powell said.

One aim of the study was to determine the validity of NCCN ovarian cancer clinical practice guidelines using a survival comparison. Adherence to the guidelines "does seem to correlate with improved survival and, perhaps, with better quality care. It translates to approximately a 13-month improved median survival for patients who were compliant," Dr. Powell said, adding this difference was "highly statistically significant" (hazard ratio, 1.44).

Adherence and survival correlated across each stage of cancer as well, Dr. Powell said.

During a Q & A session, Dr. Barbara Goff pointed out that some noncompliant care was delivered to patients at one of the 21 major institutions that form the NCCN. "I was surprised that only about 50%-55% of the time were patients at NCCN institutions receiving guideline-based therapy," said Dr. Goff, professor of gynecologic oncology at the University of Washington, Seattle.

"We were quite surprised adherence was that low at centers that write the guidelines," Dr. Powell responded. A higher percentage of referred patients, a lack of information on patients who intentionally decline treatment, and/or less-than-ideal documentation in the database could be contributing factors, he said. "This is obviously a focus for future research."

Patient, tumor, and treatment characteristics were considered in the 5-year survival analysis. "As we all would guess, stage was predictive, with advancing stage [associated] with worse survival," Dr. Powell said. Patients with higher grade cancers also fared worse.

Dr. Powell and his associates also assessed their data according to center volume. For example, in the lowest volume centers (with one to six cases per year), adherence was 40% and median survival was 31 months. At the highest volume centers (with 26 or more cases per year), adherence was 55% and median survival increased to 46 months.

Asked if factors such as increasing age and comorbidity could result in nonadherent, yet appropriate care, Dr. Powell responded. "It’s clear patients with more comorbidities tend to not have NCCN-compliant care." He added, "We want to set a bar and evaluate based on that bar, but it doesn’t mean there cannot be exceptions, patient factors and others.

"We need to measure what we are doing before we can improve," Dr. Powell said. The Society of Gynecologic Oncologists just created a Quality and Data Outcomes Committee designed to assess and measure quality of care as physician performance comes under increased reimbursement pressure in the next few years.

Dr. Powell said he had no relevant disclosures.

ORLANDO – Improper surgery, a lack of lymph node assessment, and improper or no chemotherapy top the list of reasons that women with ovarian cancer do not receive care consistent with National Comprehensive Cancer Network guidelines, according to a study of nearly 100,000 patients.

"Overall, we were quite sad to see that only 43% of patients appear to be receiving care adherent with the NCCN guidelines," Dr. Matthew A. Powell said at this year’s annual meeting of the Society of Gynecologic Oncologists (SGO). "The reasons for nonadherence were mostly surgical in nature."

Dr. Matthew A. Powell

Researchers assessed treatment of 96,802 women diagnosed with invasive epithelial ovarian cancer in the National Cancer Database from 1998 to 2007. They also evaluated mature 5-year survival data from 1998 to 2002.

To determine guideline adherence, Dr. Powell and his associates noted initial surgical procedure and initial front-line chemotherapy. They also assessed compliance by cancer stage, substage, and grade.

The primary reason for nonadherence was a lack of documented omentectomy (54,939 or 57% of the nonadherent cases). "In those patients who did have an omentectomy and stage I to IIIb cancer, we required them to have lymph node assessment," Dr. Powell said. "Unfortunately this also represented a large portion of the nonadherence."

Improper chemotherapy comprised the remainder of nonadherent cases, where patients received single-agent chemotherapy, no chemotherapy, or inappropriate chemotherapy based on cancer stage and grade.

Patients who underwent surgery only (with no evidence of chemotherapy in their records) included a large portion with stage IIIc and IV disease, Dr. Powell said. Only 8% of this cohort received care consistent with the National Comprehensive Cancer Network (NCCN) guidelines.

"One-third of patients had two or three reasons to be nonadherent to the guidelines," said Dr. Powell, who is on the obstetrics and gynecology faculty, Division of Gynecologic Oncology at the Washington University, St. Louis.

The NCCN established the ovarian cancer guidelines in 1997, and they underwent regular revisions, including major updates in 2000 and 2006, Dr. Powell said.

One aim of the study was to determine the validity of NCCN ovarian cancer clinical practice guidelines using a survival comparison. Adherence to the guidelines "does seem to correlate with improved survival and, perhaps, with better quality care. It translates to approximately a 13-month improved median survival for patients who were compliant," Dr. Powell said, adding this difference was "highly statistically significant" (hazard ratio, 1.44).

Adherence and survival correlated across each stage of cancer as well, Dr. Powell said.

During a Q & A session, Dr. Barbara Goff pointed out that some noncompliant care was delivered to patients at one of the 21 major institutions that form the NCCN. "I was surprised that only about 50%-55% of the time were patients at NCCN institutions receiving guideline-based therapy," said Dr. Goff, professor of gynecologic oncology at the University of Washington, Seattle.

"We were quite surprised adherence was that low at centers that write the guidelines," Dr. Powell responded. A higher percentage of referred patients, a lack of information on patients who intentionally decline treatment, and/or less-than-ideal documentation in the database could be contributing factors, he said. "This is obviously a focus for future research."

Patient, tumor, and treatment characteristics were considered in the 5-year survival analysis. "As we all would guess, stage was predictive, with advancing stage [associated] with worse survival," Dr. Powell said. Patients with higher grade cancers also fared worse.

Dr. Powell and his associates also assessed their data according to center volume. For example, in the lowest volume centers (with one to six cases per year), adherence was 40% and median survival was 31 months. At the highest volume centers (with 26 or more cases per year), adherence was 55% and median survival increased to 46 months.

Asked if factors such as increasing age and comorbidity could result in nonadherent, yet appropriate care, Dr. Powell responded. "It’s clear patients with more comorbidities tend to not have NCCN-compliant care." He added, "We want to set a bar and evaluate based on that bar, but it doesn’t mean there cannot be exceptions, patient factors and others.

"We need to measure what we are doing before we can improve," Dr. Powell said. The Society of Gynecologic Oncologists just created a Quality and Data Outcomes Committee designed to assess and measure quality of care as physician performance comes under increased reimbursement pressure in the next few years.

Dr. Powell said he had no relevant disclosures.

ORLANDO – Improper surgery, a lack of lymph node assessment, and improper or no chemotherapy top the list of reasons that women with ovarian cancer do not receive care consistent with National Comprehensive Cancer Network guidelines, according to a study of nearly 100,000 patients.

"Overall, we were quite sad to see that only 43% of patients appear to be receiving care adherent with the NCCN guidelines," Dr. Matthew A. Powell said at this year’s annual meeting of the Society of Gynecologic Oncologists (SGO). "The reasons for nonadherence were mostly surgical in nature."

Dr. Matthew A. Powell

Researchers assessed treatment of 96,802 women diagnosed with invasive epithelial ovarian cancer in the National Cancer Database from 1998 to 2007. They also evaluated mature 5-year survival data from 1998 to 2002.

To determine guideline adherence, Dr. Powell and his associates noted initial surgical procedure and initial front-line chemotherapy. They also assessed compliance by cancer stage, substage, and grade.

The primary reason for nonadherence was a lack of documented omentectomy (54,939 or 57% of the nonadherent cases). "In those patients who did have an omentectomy and stage I to IIIb cancer, we required them to have lymph node assessment," Dr. Powell said. "Unfortunately this also represented a large portion of the nonadherence."

Improper chemotherapy comprised the remainder of nonadherent cases, where patients received single-agent chemotherapy, no chemotherapy, or inappropriate chemotherapy based on cancer stage and grade.

Patients who underwent surgery only (with no evidence of chemotherapy in their records) included a large portion with stage IIIc and IV disease, Dr. Powell said. Only 8% of this cohort received care consistent with the National Comprehensive Cancer Network (NCCN) guidelines.

"One-third of patients had two or three reasons to be nonadherent to the guidelines," said Dr. Powell, who is on the obstetrics and gynecology faculty, Division of Gynecologic Oncology at the Washington University, St. Louis.

The NCCN established the ovarian cancer guidelines in 1997, and they underwent regular revisions, including major updates in 2000 and 2006, Dr. Powell said.

One aim of the study was to determine the validity of NCCN ovarian cancer clinical practice guidelines using a survival comparison. Adherence to the guidelines "does seem to correlate with improved survival and, perhaps, with better quality care. It translates to approximately a 13-month improved median survival for patients who were compliant," Dr. Powell said, adding this difference was "highly statistically significant" (hazard ratio, 1.44).

Adherence and survival correlated across each stage of cancer as well, Dr. Powell said.

During a Q & A session, Dr. Barbara Goff pointed out that some noncompliant care was delivered to patients at one of the 21 major institutions that form the NCCN. "I was surprised that only about 50%-55% of the time were patients at NCCN institutions receiving guideline-based therapy," said Dr. Goff, professor of gynecologic oncology at the University of Washington, Seattle.

"We were quite surprised adherence was that low at centers that write the guidelines," Dr. Powell responded. A higher percentage of referred patients, a lack of information on patients who intentionally decline treatment, and/or less-than-ideal documentation in the database could be contributing factors, he said. "This is obviously a focus for future research."

Patient, tumor, and treatment characteristics were considered in the 5-year survival analysis. "As we all would guess, stage was predictive, with advancing stage [associated] with worse survival," Dr. Powell said. Patients with higher grade cancers also fared worse.

Dr. Powell and his associates also assessed their data according to center volume. For example, in the lowest volume centers (with one to six cases per year), adherence was 40% and median survival was 31 months. At the highest volume centers (with 26 or more cases per year), adherence was 55% and median survival increased to 46 months.

Asked if factors such as increasing age and comorbidity could result in nonadherent, yet appropriate care, Dr. Powell responded. "It’s clear patients with more comorbidities tend to not have NCCN-compliant care." He added, "We want to set a bar and evaluate based on that bar, but it doesn’t mean there cannot be exceptions, patient factors and others.

"We need to measure what we are doing before we can improve," Dr. Powell said. The Society of Gynecologic Oncologists just created a Quality and Data Outcomes Committee designed to assess and measure quality of care as physician performance comes under increased reimbursement pressure in the next few years.

Dr. Powell said he had no relevant disclosures.

ORLANDO – Improper surgery, a lack of lymph node assessment, and improper or no chemotherapy top the list of reasons that women with ovarian cancer do not receive care consistent with National Comprehensive Cancer Network guidelines, according to a study of nearly 100,000 patients.

"Overall, we were quite sad to see that only 43% of patients appear to be receiving care adherent with the NCCN guidelines," Dr. Matthew A. Powell said at this year’s annual meeting of the Society of Gynecologic Oncologists (SGO). "The reasons for nonadherence were mostly surgical in nature."

Dr. Matthew A. Powell

Researchers assessed treatment of 96,802 women diagnosed with invasive epithelial ovarian cancer in the National Cancer Database from 1998 to 2007. They also evaluated mature 5-year survival data from 1998 to 2002.

To determine guideline adherence, Dr. Powell and his associates noted initial surgical procedure and initial front-line chemotherapy. They also assessed compliance by cancer stage, substage, and grade.

The primary reason for nonadherence was a lack of documented omentectomy (54,939 or 57% of the nonadherent cases). "In those patients who did have an omentectomy and stage I to IIIb cancer, we required them to have lymph node assessment," Dr. Powell said. "Unfortunately this also represented a large portion of the nonadherence."

Improper chemotherapy comprised the remainder of nonadherent cases, where patients received single-agent chemotherapy, no chemotherapy, or inappropriate chemotherapy based on cancer stage and grade.

Patients who underwent surgery only (with no evidence of chemotherapy in their records) included a large portion with stage IIIc and IV disease, Dr. Powell said. Only 8% of this cohort received care consistent with the National Comprehensive Cancer Network (NCCN) guidelines.

"One-third of patients had two or three reasons to be nonadherent to the guidelines," said Dr. Powell, who is on the obstetrics and gynecology faculty, Division of Gynecologic Oncology at the Washington University, St. Louis.

The NCCN established the ovarian cancer guidelines in 1997, and they underwent regular revisions, including major updates in 2000 and 2006, Dr. Powell said.

One aim of the study was to determine the validity of NCCN ovarian cancer clinical practice guidelines using a survival comparison. Adherence to the guidelines "does seem to correlate with improved survival and, perhaps, with better quality care. It translates to approximately a 13-month improved median survival for patients who were compliant," Dr. Powell said, adding this difference was "highly statistically significant" (hazard ratio, 1.44).

Adherence and survival correlated across each stage of cancer as well, Dr. Powell said.

During a Q & A session, Dr. Barbara Goff pointed out that some noncompliant care was delivered to patients at one of the 21 major institutions that form the NCCN. "I was surprised that only about 50%-55% of the time were patients at NCCN institutions receiving guideline-based therapy," said Dr. Goff, professor of gynecologic oncology at the University of Washington, Seattle.

"We were quite surprised adherence was that low at centers that write the guidelines," Dr. Powell responded. A higher percentage of referred patients, a lack of information on patients who intentionally decline treatment, and/or less-than-ideal documentation in the database could be contributing factors, he said. "This is obviously a focus for future research."

Patient, tumor, and treatment characteristics were considered in the 5-year survival analysis. "As we all would guess, stage was predictive, with advancing stage [associated] with worse survival," Dr. Powell said. Patients with higher grade cancers also fared worse.

Dr. Powell and his associates also assessed their data according to center volume. For example, in the lowest volume centers (with one to six cases per year), adherence was 40% and median survival was 31 months. At the highest volume centers (with 26 or more cases per year), adherence was 55% and median survival increased to 46 months.

Asked if factors such as increasing age and comorbidity could result in nonadherent, yet appropriate care, Dr. Powell responded. "It’s clear patients with more comorbidities tend to not have NCCN-compliant care." He added, "We want to set a bar and evaluate based on that bar, but it doesn’t mean there cannot be exceptions, patient factors and others.

"We need to measure what we are doing before we can improve," Dr. Powell said. The Society of Gynecologic Oncologists just created a Quality and Data Outcomes Committee designed to assess and measure quality of care as physician performance comes under increased reimbursement pressure in the next few years.

Dr. Powell said he had no relevant disclosures.

ORLANDO – Improper surgery, a lack of lymph node assessment, and improper or no chemotherapy top the list of reasons that women with ovarian cancer do not receive care consistent with National Comprehensive Cancer Network guidelines, according to a study of nearly 100,000 patients.

"Overall, we were quite sad to see that only 43% of patients appear to be receiving care adherent with the NCCN guidelines," Dr. Matthew A. Powell said at this year’s annual meeting of the Society of Gynecologic Oncologists (SGO). "The reasons for nonadherence were mostly surgical in nature."

Dr. Matthew A. Powell

Researchers assessed treatment of 96,802 women diagnosed with invasive epithelial ovarian cancer in the National Cancer Database from 1998 to 2007. They also evaluated mature 5-year survival data from 1998 to 2002.

To determine guideline adherence, Dr. Powell and his associates noted initial surgical procedure and initial front-line chemotherapy. They also assessed compliance by cancer stage, substage, and grade.

The primary reason for nonadherence was a lack of documented omentectomy (54,939 or 57% of the nonadherent cases). "In those patients who did have an omentectomy and stage I to IIIb cancer, we required them to have lymph node assessment," Dr. Powell said. "Unfortunately this also represented a large portion of the nonadherence."

Improper chemotherapy comprised the remainder of nonadherent cases, where patients received single-agent chemotherapy, no chemotherapy, or inappropriate chemotherapy based on cancer stage and grade.

Patients who underwent surgery only (with no evidence of chemotherapy in their records) included a large portion with stage IIIc and IV disease, Dr. Powell said. Only 8% of this cohort received care consistent with the National Comprehensive Cancer Network (NCCN) guidelines.

"One-third of patients had two or three reasons to be nonadherent to the guidelines," said Dr. Powell, who is on the obstetrics and gynecology faculty, Division of Gynecologic Oncology at the Washington University, St. Louis.

The NCCN established the ovarian cancer guidelines in 1997, and they underwent regular revisions, including major updates in 2000 and 2006, Dr. Powell said.

One aim of the study was to determine the validity of NCCN ovarian cancer clinical practice guidelines using a survival comparison. Adherence to the guidelines "does seem to correlate with improved survival and, perhaps, with better quality care. It translates to approximately a 13-month improved median survival for patients who were compliant," Dr. Powell said, adding this difference was "highly statistically significant" (hazard ratio, 1.44).

Adherence and survival correlated across each stage of cancer as well, Dr. Powell said.

During a Q & A session, Dr. Barbara Goff pointed out that some noncompliant care was delivered to patients at one of the 21 major institutions that form the NCCN. "I was surprised that only about 50%-55% of the time were patients at NCCN institutions receiving guideline-based therapy," said Dr. Goff, professor of gynecologic oncology at the University of Washington, Seattle.

"We were quite surprised adherence was that low at centers that write the guidelines," Dr. Powell responded. A higher percentage of referred patients, a lack of information on patients who intentionally decline treatment, and/or less-than-ideal documentation in the database could be contributing factors, he said. "This is obviously a focus for future research."

Patient, tumor, and treatment characteristics were considered in the 5-year survival analysis. "As we all would guess, stage was predictive, with advancing stage [associated] with worse survival," Dr. Powell said. Patients with higher grade cancers also fared worse.

Dr. Powell and his associates also assessed their data according to center volume. For example, in the lowest volume centers (with one to six cases per year), adherence was 40% and median survival was 31 months. At the highest volume centers (with 26 or more cases per year), adherence was 55% and median survival increased to 46 months.

Asked if factors such as increasing age and comorbidity could result in nonadherent, yet appropriate care, Dr. Powell responded. "It’s clear patients with more comorbidities tend to not have NCCN-compliant care." He added, "We want to set a bar and evaluate based on that bar, but it doesn’t mean there cannot be exceptions, patient factors and others.

"We need to measure what we are doing before we can improve," Dr. Powell said. The Society of Gynecologic Oncologists just created a Quality and Data Outcomes Committee designed to assess and measure quality of care as physician performance comes under increased reimbursement pressure in the next few years.

Dr. Powell said he had no relevant disclosures.