Gynecologic oncologists at Yale are "bullish" on a new method of care for ovarian cancer. While the standard treatment for the last three decades includes surgical debulking followed by chemotherapy, Yale gynecologic oncologists, Dr. Peter Schwartz and Dr. Thomas Rutherford, utilize a new approach. "Based on extensive studies and experience, we now advocate the use of neoadjuvent chemotherapy before surgery in patients with unresectable disease," explained Thomas Rutherford, M.D. "We have found that the chemotherapy reduces the fluid build up in the abdomen and shrinks the tumor. It’s amazing to me. What seems like an unresectable tumor at the initial CT scan can now be debulked with a great deal of success," he said. "This is a critical point because we know that when an ovarian tumor is removed completely, long-term survival increases."

According to Dr. Peter Schwartz, Yale gynecological oncologist working with Rutherford, "We have found that if we operate first and there is fluid in the lungs and abdomen, we had more difficult recoveries, longer time periods in intensive care and more post-op complications." The team’s most recent study comparing neoadjuvent chemotherapy to post-operative chemotherapy has shown no reduction in survival rate. "But recovery is quicker and there are fewer complications from surgery, and hospital length of stay is shorter," added Schwartz.

The Yale study, published in the March 1999 issue of Gynecologic Oncology, included 59 women with advanced ovarian cancer who received neoadjuvent chemotherapy before surgery. Their experiences were compared to those of 206 women with chemotherapy following surgical debulking. According to Dr. Rutherford, the women who underwent neoadjuvent chemotherapy prior to surgery recovered more rapidly than those who have aggressive chemotherapy after surgery. "It is easier to resect a smaller tumor, which occurs when we do chemotherapy first," added Dr. Rutherford.

"There are many studies that unequivocally show that a good prognosis is tied to how effectively all of the gross cancer is removed. Our experience has been that this is a much easier goal to achieve when we perform the chemotherapy first," Dr. Schwartz noted.

For more information, contact Dr. Thomas Rutherford or Dr. Peter Schwartz.