[Neoadjuvant chemotherapy for ovarian cancer]

The current standard treatment for advanced ovarian cancer is primary debulking surgery (PDS) followed by postsurgical chemotherapy. We can expect better prognosis in cases where optimal debulking (residual diseases<1 cm) can be achieved. Neoadjuvant chemotherapy (NAC) has been recognized as an alternative treatment to primary surgical debulking for patients with poor performance status or apparently unresectable bulky tumors. Retrospective analyses and non-randomized comparative studies revealed that overall survival was comparable between patients treated with NAC followed by interval debulking surgery (IDS) and those treated with PDS, though the former group had more advanced disease and poorer performance status. Two reports of meta-analyses of these studies revealed that the NAC setting treatment does not compromise the treatment outcome of the patients with advanced ovarian cancer. Until now, at least four phase III studies comparing NAC setting treatment with standard treatment for advanced müllerian cancer have been conducted. The results of the first study conducted by the European Organization for Research and Treatment of Cancer (EORTC) were published in 2010. They revealed a comparative outcome of NAC setting treatment with standard treatment (median survival 30 M vs 29 M) with less common surgery-related adverse effects. NAC setting treatment is now expected to become a standard treatment or one of the effective treatment options for advanced ovarian cancer in cases when other phase III studies reproduce similar results.