title: Does neoadjuvant chemotherapy plus cytoreductive surgery improve survival rates in patients with advanced epithelial ovarian cancer compared with cytoreductive surgery alone?
abstract: OBJECTIVE
  To compare the outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC/IDS) with primary debulking surgery (PDS) in patients diagnosed with advanced epithelial ovarian cancer (EOC).
  
  
  METHODS
  A total of 292 patients with stages IIIC and IV disease who were treated with either NAC/IDS or PDS between 1995 and 2012 were retrospectively reviewed. The study population was divided into two groups: the NAC/IDS group (N=84) and the PDS group (N=208). Progression-free survival (PFS), overall survival (OS), and optimal cytoreduction were compared.
  
  
  RESULTS
  The mean age was significantly higher in the NAC/IDS group (61.5±11.5 vs 57.8±11.1 years, p=0.01). Optimal cytoreduction was achieved in 34.5% (29/84) of the patients in the NAC/IDS group and in 32.2% (69/208) in the PDS group (p=0.825). The survival rates were comparable. The mean survival rate of patients who achieved optimal cytoreductive surgery in either the PDS or the NAC/IDS arm was significantly higher than that of patients who achieved suboptimal cytoreductive surgery (p<0.001 and p<0.001, respectively). Multivariate analysis confirmed the treatment method, amount of ascitic fluid, and optimal cytoreduction as independent factors for OS.
  
  
  CONCLUSIONS
  No definitive evidence was noticed regarding whether NAC/IDS increases survival compared with PDS. NAC should be reserved for patients who cannot tolerate PDS or when optimal cytoreduction is not feasible.
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Ulas
authors.initials: U
authors.lastname: Solmaz
authors.forename: Emre
authors.initials: E
authors.lastname: Mat
authors.forename: Murat
authors.initials: M
authors.lastname: Levent Dereli
authors.forename: Volkan
authors.initials: V
authors.lastname: Turan
authors.forename: Nuri
authors.initials: N
authors.lastname: Peker
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tosun
authors.forename: Askin
authors.initials: A
authors.lastname: Dogan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Adiyeke
authors.forename: Aykut
authors.initials: A
authors.lastname: Ozdemir
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Sanci
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yildirim
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate