Practical guidelines for triage to neoadjuvant chemotherapy in advanced ovarian cancer: Big risk, big reward…or too much risk?

Abstract

The triage of patients with advanced epithelial ovarian cancer (EOC) to neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) is a source of longstanding controversy within the gynecologic oncology community. Four major randomized controlled trials (RCTs) have demonstrated comparable survival outcomes between NACT and PDS, and are commonly referenced as justification for the increasing practice of triaging patients with advanced EOC to upfront chemotherapy [1–4]. The generalizability of these results to the properly selected patient, however, has been called into question by fierce advocates for PDS, who cite previous prospective and retrospective studies that have consistently reported the longest survival times among patients who have undergone PDS and achieved a complete gross resection (CGR) of disease [5,6].