OA: Commentary - Neo-adjuvant chemotherapy in stage IIIC potentially resectable epithelial ovarian cancer

Neo-adjuvant chemotherapy in stage IIIC potentially resectable epithelial ovarian cancer
 20 November 2016

Correspondence

Neo-adjuvant chemotherapy in stage IIIC potentially resectable epithelial ovarian cancer 

Ioannis A. Voutsadakis

 I would like to comment on the recently (October 2016 issue of Gynecologic Oncology) published guideline for neoadjuvant chemotherapy (NACT) in newly diagnosed ovarian cancer and specifically with regards to potentially resectable disease (Recommendation 3.1) (Wright et al., 2016). The decision to proceed with NACT or primary surgery (PCS) in newly diagnosed stage IIIC disease should not be confused with the decision of whether surgery is at all appropriate in a given patient because of her general condition or comorbidities. This should be clarified first and be distinct from the decision of timing of cytoreductive surgery. The appropriateness of surgery may of course be modified if there is a progression during NACT (as Recommendation 7 of the guideline advocates) or conversely if an unexpected improvement of the clinical condition of the patient is obtained during palliative chemotherapy. Availability of the NACT option should not be an “excuse” for not operating on a potentially resectable patient because of other comorbidities that would increase her surgical complication risk or because of concerns of inexperienced surgeons that a primary debulking surgery would be more difficult. Instead the general status of the patient should weight in the decision of proceeding with NACT only if it is believed to be related to the burden of the cancer and patients that are expected to be technically more difficult should be referred to more experienced centers.....

 References

1. • Bristow et al., 2002
2. • Chang, 2016
3. • Cocco et al., 2015|
4. • Hynninen et al., 2013
5. • Kehoe et al., 2015|
6. • Pinder et al., 2015
7. • van Meurs et al., 2013
8. • Vergote et al., 2010 
9. • Wright et al., 2016|