| Abstract: |
Ovarian cancer has been treated for the last several decades with aggressive surgical debulking followed by cytotoxic chemotherapy. While optimal cytoreduction continues to be defined as residual disease <1. cm in largest diameter, numerous studies have demonstrated a survival advantage with complete gross resection of tumor. To increase the likelihood of leaving no residual disease, a radical surgical approach incorporating bowel surgery as well as upper abdominal and thoracic procedures has evolved.Despite this, some patients have extensive disease precluding optimal debulking, while others are not medically fit for complex surgery. Neoadjuvant chemotherapy (NACT) has been advocated for these cases. Randomized data out of Europe have suggested that survival outcomes with NACT are comparable to those of primary debulking surgery (PDS) in bulky, stage III/IV disease. However, overall survival in these and other comparison studies has been dismal.In this chapter, we review the ongoing debate of NACT versus PDS and discuss current methods for predicting "debulkability" and for triaging appropriate patients to NACT. © 2017 Elsevier Inc. All rights reserved. |
