title: Appropriate Recommendations for Surgical Debulking in Stage IV Ovarian Cancer.
abstract: Epithelial ovarian cancer continues to be the leading cause of death due to gynecologic malignancy, and it is the fifth leading cause of cancer death in women in the USA and seventh worldwide. In most women with ovarian cancer, the disease is diagnosed at an advanced stage and primary cytoreductive surgery is considered standard of care. Traditionally, the gynecologic oncology literature supports the dictum that aggressive radical debulking to reduce intra-abdominal tumor burden to minimal or less than 1 cm of disease has significant impact on overall survival. However, the European Organization for Research and Treatment of Cancer (EORTC) trial found that survival after neoadjuvant followed by interval debulking surgery was similar to survival with the standard approach of primary surgery followed by chemotherapy. Many gynecologic oncologists have now adopted neoadjuvant chemotherapy for the treatment of stage IV ovarian cancer given the complex nature of this disease. Currently, there are conflicting results in the literature with regards to neoadjuvant chemotherapy versus primary debulking for stage IV ovarian cancer. While there is evidence that neoadjuvant treatment is not inferior to primary debulking, the literature also supports that maximizing debulking efforts with radical surgery can provide a survival benefit in patients with stage IV ovarian carcinoma.
authors.affiliation: Department of Obstetrics and Gynecology, NYU Langone Medical Center, NYU School of Medicine, 550 First Ave, NBV 9E2, New York, NY, 10016, USA. Jing-Yi.Chern@nyumc.org.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Chern
authors.affiliation: Department of Obstetrics and Gynecology, NYU Langone Medical Center, NYU School of Medicine, 550 First Ave, NBV 9E2, New York, NY, 10016, USA. John.Curtin@nyumc.org.
authors.forename: John P
authors.initials: JP
authors.lastname: Curtin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures / Q000592:standards; D018450:Disease Progression; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Optimal cytoreduction; Radical debulking; Stage IV ovarian cancer