Chemotherapy before surgery benefits patients with advanced ovarian cancer

Women with advanced ovarian cancer have fewer side effects and tend to have a better quality of life if given chemotherapy before surgery, according to a study published in The Lancet (2015; doi:10.1016/S0140-6736).

The CHORUS trial, conducted by Cancer Research United Kingdom at the Medical Research Council Clinical Trials Unit at University College London, challenged the international standard for treating advanced ovarian cancer.

The trial enrolled 550 women with advanced ovarian cancer, with 276 given the standard treatment of surgery followed by six cycles of chemotherapy, and 274 having had surgery after three cycles of chemotherapy.

The Cancer Research UK funded trial found that postsurgery complications and death within 28 days of surgery was most common among women given surgery first. Women who received delayed surgery suffered fewer symptoms, a reduction in overall side effects, and had a lower death rate.

Delaying surgery also reduced the amount of time the patient spent in the hospital after surgery, which is a benefit to both the patient and resources.

The CHORUS trial is the largest surgical trial of its kind in the UK and second largest in the world. It aimed to see if this new treatment strategy was a good alternative to the traditional approach.

"The trial showed that shrinking the tumor before surgery reduced side effects and hospital stay, meaning improved quality of life, without compromising survival, which is better for patients,” said author Professor Sean Kehoe, MD, study author and professor of gynecological cancer at the University of Birmingham in the UK.

“We are so thankful to the women who took part in the trial and their families, as we couldn't have done this important research without them. Because of their generosity we can improve the lives of others."

Ovarian cancer is the most common cause of death among gynecologic cancers.

"This is a great example of how research can help us to plan the best care for people with cancer,” said Professor Peter Johnson, MD, chief clinician at Cancer Research UK.

“Whether to have chemotherapy before major surgery for ovarian cancer has always been a dilemma for women and their surgeons. Thanks to this study we can say that having chemotherapy first makes the surgery safer, the stay in hospital shorter and women's quality of life better. These are important results that will make a big difference to many women in the future," said Johnson.

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