Advanced disease: FIGO III-IV The standard treatment for patients with advanced ovarian cancer is maximal surgical cytoreduction (total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and omentectomy) followed by systemic platinum-based chemotherapy and, actually, is reasonable to expect a 5-year survival for 10-30% of women diagnosed with ovarian cancer at stage III or IV (34). The concept of primary debulking surgery is to diminish the residual tumor burden to a point at which adjuvant therapy will be optimally effective. The percentage of patients with advanced ovarian cancer who can optimally undergo cytoreductive surgery seems to range from 17%-87% (35), depending on the report reviewed. This percentage can largely depend on the experience of the surgeon.
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This phase III randomized study compared primary debulking surgery followed by chemotherapy with neoadjuvant chemotherapy followed by interval debulking surgery in patients with advanced ovarian cancer. The median overall survival was 29 months in the primary-surgery group and 30 months in the neoadjuvant chemotherapy group and this difference was not statistically significant. Also, n difference was observed in median progression-free survival. These results are thoroughly discussed among the experts in this field; it is believed that upfront maximal cytoreduction is still the standard, although further research should focus on how to select patients that cannot receive optimal cytoreduction and that can benefit from a neoadjuvant strategy. When deciding debulking surgery, we should assess predictive factors with respect to recidual macroscopic disease after debulking surgery which is the strongest independent variable in predicting survival
This phase III randomized study compared primary debulking surgery followed by chemotherapy with neoadjuvant chemotherapy followed by interval debulking surgery in patients with advanced ovarian cancer. The median overall survival was 29 months in the primary-surgery group and 30 months in the neoadjuvant chemotherapy group and this difference was not statistically significant. Also, n difference was observed in median progression-free survival. These results are thoroughly discussed among the experts in this field; it is believed that upfront maximal cytoreduction is still the standard, although further research should focus on how to select patients that cannot receive optimal cytoreduction and that can benefit from a neoadjuvant strategy. When deciding debulking surgery, we should assess predictive factors with respect to recidual macroscopic disease after debulking surgery which is the strongest independent variable in predicting survival