Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer

Background: Inappropriatelyovarian cancer cannot be detected until an advancedstage. Radical debulking surgery is considered the cornerstone in themanagement of advanced ovarian cancer pointing to complete tumor resolution.Unless optimal debulking cannot be achieved, these patients gain little benefitfrom surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a noveltherapeutic modality to a diversity of malignant tumors when the disease is notwilling to optimal surgical resection at the time of diagnosis or the patientwho unfit for aggressive debulking surgery. The purpose of this study isto compare survival in the patient with advanced ovarian cancer (stage III/IV)underwent primary debulking surgery followed by adjuvant chemotherapy(PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreasedin surgical morbidity in comparison to primary debulking surgery (PDS-ACTR).NACT-IDS showed significant improvement in progression-free survival (P-value0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Responseto NACT and residual volume were the twoindependent prognostic factors foroverall survival. Conclusion: NACT-IDSfor advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity andsignificant increase progression-free survival and overall survival. Both responsesto NACT and residual tumor volume were the two independent prognostic factors for survival in ovariancancer.