Correspondence
Carboplatin plus paclitaxel scheduling for advanced ovarian cancer The Article by Sandro Pignata and colleagues1 describes the MITO-7 trial, in which a weekly paclitaxel plus carboplatin regimen in women with advanced epithelial ovarian cancer was associated with better quality of life and fewer toxic effects than the same drugs given every 3 weeks, but not with increased progressionfree survival. A Comment on this study by Mahner and Burges2 raised the question of whether the high proportion of patients who were not operated on (25% in the weekly group, 24% in the 3-week group) or who underwent interval debulking (20% in the weekly group, 17% in the 3-week group) could make the results difficult to translate into routine practice. Although little information was provided by Pignata and colleagues1 about the quality of cytoreductive surgery in their study, and no surgical factor was included in the eligibility criteria, we have the following related comments. First, only 53% of patients in both groups had post-surgical residual disease of 1 cm or less (random allocation was stratified by completeness of cytoreduction). In a previous study by Chi and colleagues,3 up to 80% of patients in specialised centres had cytoreduction to 1 cm or less with more aggressive and complete surgical cytoreductive procedures. Additionally, higher proportions of optimum cytoreduction have been reported in highly selective case series.4 Second, complete resection of all macroscopic disease was the strongest predictor of progression-free survival by multivariate analysis (p90 patients), intermediate-volume (20–89 patients), or small-volume (
Carboplatin plus paclitaxel scheduling for advanced ovarian cancer The Article by Sandro Pignata and colleagues1 describes the MITO-7 trial, in which a weekly paclitaxel plus carboplatin regimen in women with advanced epithelial ovarian cancer was associated with better quality of life and fewer toxic effects than the same drugs given every 3 weeks, but not with increased progressionfree survival. A Comment on this study by Mahner and Burges2 raised the question of whether the high proportion of patients who were not operated on (25% in the weekly group, 24% in the 3-week group) or who underwent interval debulking (20% in the weekly group, 17% in the 3-week group) could make the results difficult to translate into routine practice. Although little information was provided by Pignata and colleagues1 about the quality of cytoreductive surgery in their study, and no surgical factor was included in the eligibility criteria, we have the following related comments. First, only 53% of patients in both groups had post-surgical residual disease of 1 cm or less (random allocation was stratified by completeness of cytoreduction). In a previous study by Chi and colleagues,3 up to 80% of patients in specialised centres had cytoreduction to 1 cm or less with more aggressive and complete surgical cytoreductive procedures. Additionally, higher proportions of optimum cytoreduction have been reported in highly selective case series.4 Second, complete resection of all macroscopic disease was the strongest predictor of progression-free survival by multivariate analysis (p90 patients), intermediate-volume (20–89 patients), or small-volume (
