What are the differences between neoadjuvant or adjuvant chemotherapy?

Posted in ovarian cancer, chemotherapy; Posted 3 years ago by Andreas Obermair

Neoadjuvant chemotherapy refers to the use of chemotherapy to shrink the cancerous tumours prior to surgery. When chemotherapy is used after surgery, it is referred to as adjuvant chemotherapy.

The aim of chemotherapy for ovarian cancer is to either eradicate the cancer, or stop the growth of cancerous cells. It is also used to prolong and improve quality of life when a cure is not possible. Chemotherapy is generally given in multiple courses over a set period of time, and is usually delivered via an intravenous drip into a vein.

Neoadjuvant chemotherapy and ovarian cancer

Most women with ovarian cancer will require chemotherapy in the course of their treatment.

For the majority of women with stages 3 or 4 ovarian cancer, chemotherapy before surgery will be used to shrink the cancerous tumours. The aim of this is to make the tumours easier to remove surgically. This typically involves three cycles of neoadjuvant chemotherapy, followed by surgery, and then another three cycles of adjuvant chemotherapy (generally 2 to 3 weeks after surgery). A “cycle” is typically an administration of chemotherapy and in the majority of women, these administrations are 3 weeks apart. The distribution and localisation of disease, the type of ovarian cancer and patients’ overall health and medical comorbidities, are all factors that are taken into consideration when determining if neoadjuvant chemotherapy will be beneficial.

The concept of neoadjuvant chemotherapy is to helps patients get better overall quickly, so that they tolerate a major surgical operation much better. All ovarian cancer patients should be assessed by a gynaecological oncologist to determine eligibility for ovarian cancer surgery.

The aim of ovarian cancer surgery is to reduce the patients’ tumour burden as much as possible. It is generally accepted that the amount of postoperative residual tumour correlates with survival outcomes. It has been shown that in patients with advanced ovarian cancer, neoadjuvant chemotherapy was associated with a higher chance to be tumour free at the end of surgery and a higher chance to avoid severe surgical complications.

Other patients will benefit from upfront surgery. These are patients with less tumour burden and a high chance that the surgeon can remove all cancer tissue upfront. The majority of those patients will require postoperative (adjuvant) chemotherapy.

Side-effects of chemotherapy

Chemotherapy also affects the healthy cells in the body, and this can cause the patient to feel unwell. Cancer Australia lists the side effects of chemotherapy including:

• fatigue
• nausea, vomiting and loss of appetite
• pain or soreness, such as headaches, muscle pain or nerve pain
• sores in the throat or mouth
• changes to the skin, such as itching, redness, dryness and acne
• changed bowel habits
• weight gain or weight loss
• hair loss
• changes to your libido
• changes to concentration and memory
• emotional changes
• blood cell disorders, which may result in anaemia, dizziness, shortness of breath and increased risk of infections
• effects on the nervous system, such as tingling, burning or muscle weakness particularly in the hands and feet

I do not administer chemotherapy but refer my patients to a medical oncologist who is experienced in administering chemotherapy for ovarian cancer patients. 

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