title: Initial chemotherapy followed by surgical cytoreduction for the treatment of stage III/IV epithelial ovarian cancer.
abstract: OBJECTIVE
  The purpose of this study was to evaluate differences in morbidity, progression-free interval, and survival in women with advanced epithelial ovarian cancer treated with initial chemotherapy versus initial surgery.
  
  
  METHODS
  All women with epithelial ovarian cancer who were treated surgically at our hospital between January 1, 1995, and January 1, 2003, were eligible; the cases of 200 patients met the criteria and underwent retrospective chart review.
  
  
  RESULTS
  Ninety-eight patients (49%) had initial chemotherapy, and 102 patients (51%) had initial surgery. Patients who received initial chemotherapy were more likely to have stage IV disease (initial chemotherapy, 27%, vs initial surgery, 8%; P = .042) and grade 3 disease (initial chemotherapy, 73%, vs initial surgery, 61%; P = .025). Optimal cytoreduction was achieved more often in patients who received initial chemotherapy (initial chemotherapy, 86%, vs initial surgery, 54%; P < .001). Only optimal cytoreduction (P = .022), and not treatment choice (P = .089), had an impact on median survival.
  
  
  CONCLUSIONS
  Initial chemotherapy is a reasonable alternative to initial surgery for the treatment of selected patients with advanced epithelial ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia Health System, Charlottesville, VA 22908-0712, USA. ee6c@virginia.edu
authors.forename: Elise N
authors.initials: EN
authors.lastname: Everett
authors.forename: Amy E
authors.initials: AE
authors.lastname: French
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Stone
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Pastore
authors.forename: Amir A
authors.initials: AA
authors.lastname: Jazaeri
authors.forename: Willie A
authors.initials: WA
authors.lastname: Andersen
authors.forename: Peyton T
authors.initials: PT
authors.lastname: Taylor
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D003536:Cystadenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D018282:Cystadenocarcinoma, Mucinous / Q000188:drug therapy / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D010053:Ovary / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents