Neoadjuvant chemotherapy and surgical considerations in ovarian cancer.
OBJECTIVE
Despite advances in surgery, it is still not possible in most patients with advanced ovarian carcinoma to remove the tumour completely. For these patients the concept of primary chemotherapy followed by interval debulking has emerged. Various studies in the past few years have evaluated the feasibility and benefit of this therapeutic approach. The available data is presented and discussed in this review.


RESULTS
The indication for interval surgery was generally based on the response to chemotherapy. However, different criteria of remission were adhered to, possibly explaining the varying outcomes of the trials. The right selection of patients suitable for this approach is crucial and needs further investigation. In these cases with an unfavourable prognosis, higher tumour resection rates and longer median survival times can be achieved by the use of neoadjuvant chemotherapy.


CONCLUSIONS
Until the results of a prospective randomized study become available, the use of neoadjuvant chemotherapy followed by debulking laparotomy must still be regarded as experimental, and must not be applied outside clinical trials.
Gallo
Angelo
A
Department of Obstetrics and Gynecology, Ospedali Riuniti of Bergamo, Italy. agallo@ospedaliriuniti.bergamo.it
Frigerio
Luigi
L
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D010052:Ovariectomy / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome