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World J Obstet Gynecol. Nov 10, 2013; 2(4): 153-166
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.153
Neoadjuvant chemotherapy and cytoreductive surgery in epithelial ovarian cancer
Siriwan Tangjitgamol, Jitti Hanprasertpong, Marta Cubelli, Claudio Zamagni
Siriwan Tangjitgamol, Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis, Bangkok 10300, Thailand
Jitti Hanprasertpong, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
Marta Cubelli, Claudio Zamagni, Medical Oncology Unit, Addarii Institute of Oncology, Policlinico S. Orsola-Malpighi University Hospital, 40100 Bologna, Italy
Author contributions: Tangjitgamol S, Hanprasertpong J, Cubelli M and Claudio Z outlined the topics of discussion, performed literature review, wrote portions of the initial draft, reviewed and revised the subsequent drafts, and compiled the final manuscript; all authors reviewed, revised, compiled the manuscript, and approved the final manuscript.
Correspondence to: Siriwan Tangjitgamol, MD, Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis, 681 Samsen Road, Dusit, Bangkok 10300, Thailand. siriwanonco@yahoo.com
Telephone: +66-2-2433666 Fax: +66-2-2437907
Received: December 13, 2012
Revised: January 13, 2013
Accepted: February 5, 2013
Published online: November 10, 2013
Processing time: 339 Days and 9.1 Hours
Abstract

Ovarian cancer is one of the leading causes of death among gynecological cancers. This is because the majority of patients present with advanced stage disease. Primary debulking surgery (PDS) followed by adjuvant chemotherapy is still a mainstay of treatment. An optimal surgery, which is currently defined by leaving no gross residual tumor, is the goal of PDS. The extent of disease as well as the operative setting, including the surgeon’s skill, influences the likelihood of successful debulking. With extensive disease and a poor chance of optimal surgery or high morbidity anticipated, neoadjuvant chemotherapy (NACT) prior to primary surgery is an option. Secondary surgery after induction chemotherapy is termed interval debulking surgery (IDS). Delayed PDS or IDS is offered to patients who show some clinical response and are without progressive disease. NACT or IDS has become more established in clinical practice and there are numerous publications regarding its advantages and disadvantages. However, data on survival are limited and inconsistent. Only one large randomized trial could demonstrate that NACT was not inferior to PDS while the few randomized trials on IDS had inconsistent results. Without a definite benefit of NACT prior to surgery over PDS, one must carefully weigh the chances of safe and successful PDS against the morbidity and risks of suboptimal surgery. Appropriate selection of a patient to undergo PDS followed by chemotherapy or, preferably, to have NACT prior to surgery is very important. Some clinical characteristics from physical examination, serum tumor markers and/or findings from imaging studies may be predictive of resectability. However, no specific features have been consistently identified in the literature. This article will address the clinical data on prediction of surgical outcomes, the role of NACT, and the role of IDS.

Keywords: Advanced stage ovarian cancer; Neoadjuvant chemotherapy; Interval debulking surgery

Core tip: Neoadjuvant chemotherapy (NACT) is an option when the primary surgery is expected to be impossible or suboptimal, or when high morbidity is anticipated. Delayed primary surgery or interval debulking surgery (IDS) is performed in patients who show some clinical response to neoadjuvant or induction chemotherapy. Preoperative clinical data to predict surgical outcomes and selection criteria for primary surgery followed by adjuvant chemotherapy or for NACT followed by IDS will be discussed in this chapter.