Study designs of evaluations included in the review
Inclusion criteria were not specified for the study design. The review included individual cohorts of patients from studies of various designs including non-randomised Phase I pilot studies, non-randomised Phase II trials, retrospective case-control studies and retrospective studies.
Specific interventions included in the review
Studies that evaluated neoadjuvant chemotherapy that included cisplastin or carboplatin before attempted cytoreductive surgery were eligible for inclusion. The review defined neoadjuvant chemotherapy as a regimen aimed at avoiding a non-useful surgical procedure in patients considered optimally unresectable; studies had to report the mean number of pre-operative chemotherapy cycles and the proportion of patients who received taxanes as part of the chemotherapy regimen. Surgical cytoreduction had to be attempted after several cycles of systemic treatment and studies had to report the definition of maximal cytoreduction surgery (size of residual disease); the review defined maximal interval cytoreduction as residual disease with a maximum diameter of 2cm or less.
The included studies used fifteen different chemotherapeutic agents in various combinations (the drugs were listed) in addition to single-agent cisplatin or carboplatin. The median or mean number of pre-operative chemotherapy cycles before surgery ranged from 2.8 to 6 (based on 22 cohorts). The weighted mean maximal interval reduction was 65% (range: 0 to 100). The weighted mean proportion of patients receiving taxanes in each cohort was 47.7% (range: 0 to 100).
Participants included in the review
Studies in which more than 90% of the patients had stage III or IV epithelial ovarian cancer (according to International Federation of Gynecology and Obstetrics criteria) were eligible for inclusion. Patients undergoing neoadjuvant chemotherapy had to be diagnosed histologically using material obtained by biopsy. Studies had to report the proportion of patients with stage IV disease; this ranged from 0 to 76.5% and the weighted mean was 27.4% per cohort. The median age ranged from 53.6 to 68 years and the weighted median age of all cohorts was 61.1 years.
Outcomes assessed in the review
Studies that reported median survival time of individual cohorts of patients were eligible for inclusion in the review.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.