title: Neoadjuvant chemotherapy equalizes the optimal cytoreduction rate to primary surgery without improving survival in advanced ovarian cancer.
abstract: To evaluate results of neoadjuvant chemotherapy (NACT) following debulking surgery in patients with extensive metastatic disease and/or poor medical performance
  
  
  METHODS
  Advanced stage epithelial ovarian cancer patients were treated with either NACT followed by debulking surgery or primary surgery followed by adjuvant chemotherapy after assessment of the extent of disease by laparoscopy or laparotomy.
  
  
  RESULTS
  Out of 297, 223 patients were in the primary surgery group, whereas 74 of them met NACT criteria. Optimal cytoreduction rates were 63.2% in primary surgery group and 60.8% in NACT group, respectively (p: 0.709). In the primary surgery group, the overall survival was significantly higher (p: 0.002). Mean patient age was more advanced (p: 0.014) and the performance status of patients was poorer (p < 0.001) in NACT group. Only patient group (primary surgery or neoadjuvant chemotherapy) (p: 0.001) retained significance as predictors of survival in multivariate analyses.
  
  
  CONCLUSIONS
  Improved rate of optimal cytoreduction with NACT in advanced ovarian cancer patients does not prolong survival. The extent of disease at diagnosis is the primary determinant of survival. Randomizing patients with equally extensive disease and performance status to either NACT or primary debulking surgery in a future study will better clarify benefits attributed to NACT.
authors.affiliation: Department of Obstetrics and Gynecology, Medical School of Ankara University, Ankara, Turkey, salihtaskin@gmail.com.
authors.forename: Salih
authors.initials: S
authors.lastname: Taşkın
authors.forename: Mete
authors.initials: M
authors.lastname: Güngör
authors.forename: Fırat
authors.initials: F
authors.lastname: Ortaç
authors.forename: Derya
authors.initials: D
authors.lastname: Öztuna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology