Value of Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer: A European Perspective
Fotopoulou C (1), Sehouli J (1), Aletti G (1), Harter P (1), Mahner S (1), Querleu D (1), Chiva L (1), Gabra H (1), Colombo N (1), du Bois A (1).
The timing of debulking surgery in advanced ovarian cancer (AOC) has been the focus of debate and controversy in the international community for almost a decade.
Although supporters of primary debulking surgery (PDS) advocate significantly better overall survival (OS) and progression-free survival rates, with even a significantly favorable impact on the patterns of relapse, 4 opponents argue higher morbidity in a highly heterogeneous and often fatal disease.
For more than two decades, we have known that each 10% increase in maximal cytoreduction is associated with a 5.5% increase in median survival, even after controlling for all other known patient- and tumor-specific variables.
However, because of the unusual tumor biology and clinical behavior of AOC, with a typical diffuse peritoneal dissemination, in the majority of cases complete debulking is associated with multivisceral resections that require extensive surgical expertise, training, and infrastructural support to not lead to an exponential increase in morbidity.