REPOST: open access: Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer — NEJM (multi-national study)

Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer — NEJM

Original Article

Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer

N Engl J Med 2010; 363:943-953September 2, 2010

Letters

In most women with ovarian carcinoma, the disease is not diagnosed until it is at an advanced stage. Primary cytoreductive surgery is considered the standard of care for advanced ovarian carcinoma.1-4 However, data from prospective, randomized, controlled trials assessing the role of primary surgery in the treatment of such cases are lacking. Interval debulking surgery has not been viewed as beneficial in women with residual tumor that exceeds 1 cm in diameter after primary debulking surgery performed with the objective of maximal surgical effort by a gynecologic oncologist.5-7 As an alternative to primary debulking surgery followed by chemotherapy, some authors have investigated the use of neoadjuvant chemotherapy before cytoreductive surgery. However, results of a meta-analysis involving 835 patients suggested that neoadjuvant chemotherapy, as compared with primary debulking surgery, was associated with a worse outcome.8
We report on a randomized trial in which we compared primary debulking surgery followed by platinum-based chemotherapy and platinum-based neoadjuvant chemotherapy followed by interval debulking surgery and additional platinum-based chemotherapy in women with advanced ovarian carcinoma.............