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. 2021 Feb 5;2021(2):CD005343. doi: 10.1002/14651858.CD005343.pub5

Kehoe 2015.

Study characteristics
Methods Multi‐centre international RCT non‐inferiority trial (CHORUS)
Participants 552 women with stage IIIc/IV EOC enrolled in the UK and New Zealand
Interventions Primary surgery then 6 cycles of platinum‐based chemotherapy or 3 cycles of platinum‐based chemotherapy, surgery, then a further 3 cycles of platinum‐based chemotherapy
Outcomes OS, PFS, QoL
Surgery scheduled after 3 cycles of chemotherapy in NACT group.
Chemotherapy details:
Single agent carboplatin: NACT = 63 (23%); PDS = 66 (24%);
Carboplatin paclitaxel: NACT = 210 (77%); PDS = 207 (75%);
Carboplatin plus other chemotherapy agent: NACT = 1 (<1%); PDS = 3 (1%).
Dose modification required: NACT = 100 (39%); PDS = 87 (38%).
PDS group: 251 (91%) of 276 women started treatment as allocated; 212 (77%) had adjuvant chemotherapy.

  • 15 had primary chemotherapy:

    • 11 unfit for surgery

    • 3 clinician’s choice

    • 1 because of women's choice

  • Of the 15 who had primary chemotherapy:

    • 4 had surgery after chemotherapy (2 after four cycles)

      • 3 had more chemotherapy after surgery (2 had two cycles)

      • 1 did not have more chemotherapy after surgery

    • 11 did not have surgery after chemotherapy (7 had six cycles)

      • 5 unfit

      • 3 disease progression

      • 2 had a complete response to

      • chemotherapy

      • 1 through women's choice

  • 10 did not have surgery or chemotherapy

    • 3 died before treatment

    • 3 unfit

    • 2 withdrew from trial

    • 1 disease progression

    • 1 no malignancy


NACT group: 253 (92%) of 274 women started treatment as allocated and 217 (79%) had IDS.
Median duration of treatment was 22 weeks in both groups (NACT inter quartile range (IQR) 19 to 24 weeks; PDS IQR 17 to 24 weeks).

  • 2 had primary surgery

    • 1 unfit for primary chemotherapy,but then had six cycles after surgery

    • 1 had benign disease

  • 19 did not have chemotherapy or surgery:

    • 6 ineligible malignancy;

    • 5 died before treatment;

    • 3 no malignancy;

    • 2 deemed inoperable;

    • 3 withdrew from the trial.

  • 16 did not have more chemotherapy after surgery:

    • 6 died;

    • 3 did not have ovarian cancer;

    • 3 had surgery after the full six cycles of chemotherapy;

    • 3 because of women's choice;

    • 1 progressive disease.
Notes www.ctu.mrc.ac.uk/plugins/StudyDisplay/protocols/CHORUS protocol Version 2.0 ‐ 05 June 2008.pdf
Additional age and survival details:
< 50: OS 22.8 months (18.5 to 34.4); PFS 13.2 months (9.9 to 17.1)
50 to 70: OS 24.1 (20.6 to 28.4); PFS 11.4 (10.5 to 12.5)
>70: OS 20.8 (14.7 to 25.8); PFS 10.4 (8.8 to 12.0)
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Random assignment centrally at the Medical Research Council Clinical Trials Unit by telephone using a minimisation method with a random element. Women stratified according to randomising centre, largest radiological tumour size, clinical FIGO stage, and pre‐specified chemotherapy regimen with equal probability of assignment to each treatment arm.
2 women who had been randomised were subsequently excluded. One woman had been randomised by mistake as an administrative error and one woman was found not to have capacity to consent and was therefore ineligible for the trial
Allocation concealment (selection bias) Low risk Central randomisation by the Medical Research Council Clinical Trials Unit by telephone
Blinding of participants and personnel (performance bias)
All outcomes Unclear risk Unblinded, therefore high risk for some outcomes assessed by investigators involved with patient care (e.g. optimal debulking).
Blinding of outcome assessment (detection bias)
All outcomes Unclear risk Not reported
Incomplete outcome data (attrition bias)
All outcomes Low risk All women accounted for and analysed by ITT analysis
Selective reporting (reporting bias) Unclear risk All pertinent outcomes appear to have been reported in some capacity. Pre‐specified outcomes as per clinicaltrials.gov protocol for OS; PFS and QoL ‐ see outcomes section in methods and clinical trials.gov website Only global QoL outcomes reported at baseline, 6 months and 12 months.
Other bias Unclear risk 64 centres surgery performed by specialist gynaecological oncologists, further 23 registered centres only non‐surgical management provided. Supplementary data in table 7 shows that hysterectomy/bilateral salpingo‐oophorectomy (BSO) and omentectomy not performed in varying proportions. Unclear what effect this might have on outcomes