title: Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline.
abstract: To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer.
  
  
  
  The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature.
  
  
  
  Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality.
  
  
  
  All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to <1cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to <1cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
authors.affiliation: Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States.
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
authors.affiliation: American Society of Clinical Oncology, Alexandria, VA, United States.
authors.forename: Kari
authors.initials: K
authors.lastname: Bohlke
authors.affiliation: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Armstrong
authors.affiliation: US Oncology Research and Arizona Oncology, Tucson, AZ, United States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bookman
authors.affiliation: Mayo Clinic, Rochester, MN, United States.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.affiliation: University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.affiliation: Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, United States.
authors.forename: Don S
authors.initials: DS
authors.lastname: Dizon
authors.affiliation: Edward Cancer Center, Naperville, IL, United States.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Kash
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.affiliation: Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Olawaiye
authors.affiliation: Society of Gynecologic Oncology, Chicago, IL, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Oldham
authors.affiliation: The Ohio State University, Columbus, OH, United States.
authors.forename: Ritu
authors.initials: R
authors.lastname: Salani
authors.affiliation: Hightstown, New Jersey, United States.
authors.forename: Dee
authors.initials: D
authors.lastname: Sparacio
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, United States.
authors.forename: William P
authors.initials: WP
authors.lastname: Tew
authors.affiliation: Leuven Cancer Institute, Leuven, European Union, Belgium.
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.affiliation: Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA, United States. Electronic address: Mitchell.Edelson@jefferson.edu.
authors.forename: Mitchell I
authors.initials: MI
authors.lastname: Edelson
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; 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; D017410:Practice Guidelines as Topic
keywords: Chemotherapy; Cytoreductive surgery; Guideline; Neoadjuvant; Ovarian cancer