OA: Value of Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer: A European Perspective

Journal of Clinical Oncology

Neoadjuvant chemotherapy (NAC) and interval debulking surgery (IDS) have been considered as ways to reduce surgical morbidity; however, the oncologic safety of these approaches has never been proven in a maximal effort setting of high surgical expertise.^2,3 The inconsistent quality of the surgical trials that have addressed this matter so far; the broad variation in practice nationally and internationally; and the still unanswered questions of fragility scores, biomarkers, and valid predictors of operability have led to strong polarization and controversy worldwide, which gives a clear signal of the need for further evidence.

 Surgical outcome is affected not only by tumor biology and patient-related factors that cannot be influenced, but also by surgical and infrastructural expertise. The European Society of Gynecologic Oncology recently published criteria for the quality of AOC surgery and recommended PDS in patients expected to undergo upfront debulking to no residual tumor with a reasonable (expected) complication rate.^30,31 Caution should be heeded to not recruit NAC-IDS cases to fill the gaps that arise from suboptimal expertise and inadequate infrastructural setting.