Neoadjuvant chemotherapy and surgical considerations in ovarian cancer

Despite advances in surgery, it is still not possible in most patients with advanced ovarian carcinoma to remove the tumour completely. For these patients the concept of primary chemotherapy followed by interval debulking has emerged. Various studies in the past few years have evaluated the feasibility and benefit of this therapeutic approach. The available data is presented and discussed in this review.

The indication for interval surgery was generally based on the response to chemotherapy. However, different criteria of remission were adhered to, possibly explaining the varying outcomes of the trials. The right selection of patients suitable for this approach is crucial and needs further investigation. In these cases with an unfavourable prognosis, higher tumour resection rates and longer median survival times can be achieved by the use of neoadjuvant chemotherapy.

Until the results of a prospective randomized study become available, the use of neoadjuvant chemotherapy followed by debulking laparotomy must still be regarded as experimental, and must not be applied outside clinical trials.