Neoadjuvant chemotherapy for ovarian cancer: Pro versus con

Surgery followed by chemotherapy is the accepted treatment paradigm for patients with ovarian cancer. Recently, neoadjuvant chemotherapy (NACT) has been investigated as an option for patients whose cancers are not amenable to initial surgical resection. Published studies of NACT have shown that benefits of its use include decreased surgical morbidity and more complete interval cytoreduction. These benefits, however, have not translated into improved survival, as long-term survival rates of patients treated with neoadjuvant chemotherapy are similar to that of those who undergo suboptimal primary cytoreduction. Current methods to preoperatively predict suboptimal cytoreduction have been neither sufficiently reliable nor reproducible. Consequently, using these methods to determine which patients should be offered primary surgery versus NACT may deprive a significant number of patients the potential for optimal cytoreduction and its attendant improved survival. Surgeons and centers with expertise in cytoreductive surgery commonly report optimal cytoreduction rates of more than 70% in unselected patients with advanced ovarian cancer. Guidelines for determining which patients have unresectable disease may be useful from these centers. At the present time, only those patients, and those who are too medically infirm to tolerate a surgical procedure, should be offered a neoadjuvant approach.