title: Neoadjuvant chemotherapy in gynaecological cancers - Implications for staging.
abstract: The management of advanced gynaecological cancers remains a therapeutic challenge. Neoadjuvant chemotherapy has been used to reduce tumour size, thus facilitating subsequent local treatment in the form of surgery or radiation. For advanced epithelial ovarian cancer, data from several non-randomized and one randomized studies indicate that neoadjuvant chemotherapy followed by interval debulking surgery is a reasonable approach in patients deemed inoperable. Such an approach results in optimum debulking (no visible tumour) in approximately 40% of the patients with reduced operative morbidity. Overall and progression free-survival is comparable to the group treated with primary debulking surgery followed by chemotherapy. Neoadjuvant chemotherapy followed by surgery is associated with improved survival for women with stage IB2-IIA cervix cancer. There is a resurgence of interest for using short-course neoadjuvant chemotherapy prior to concurrent chemo-radiation. Currently, this is being tested in randomized trials.
authors.affiliation: Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: lalitaiims@yahoo.com.
authors.forename: Lalit
authors.initials: L
authors.lastname: Kumar
authors.affiliation: Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Pramanik
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Sunesh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Neerja
authors.initials: N
authors.lastname: Bhatla
authors.affiliation: Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Malik
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology
keywords: carcinoma cervix; epithelial ovarian cancer; imaging; interval debulking surgery; neoadjuvant chemotherapy; primary debulking surgery