Ovarian cancer

The current standard treatment for advanced ovarian cancer is primary debulking surgery (PDS) followed by postsurgical chemotherapy. We can expect a better prognosis in cases of optimal debulking (residual disease<1 cm). Unfortunately, optimal debulking in the PDS can be achieved in only about 40% of stage III/IV ovarian cancers as a rule. Neoadjuvant chemotherapy (NAC) has been recognized as an alternative treatment to primary surgical debulking for patients with apparently unresectable bulky tumors or poor performance status. Retrospective analyses revealed that overall survival was comparable between patients treated with NAC followed by interval debulking surgery (IDS) and those treated with PDS, though the former group had more advanced disease and poorer performance status.Based on these favorable results of NAC for patients with advanced disease or poor performance status, the target disease was extended to all cases of advanced disease, including patients without apparently unresectable tumors and good performance status in prospective studies. The European Organization for Research and Treatment of Cancer (EORTC) and The Japan Clinical Oncology Group (JCOG) is now conducting a phase III study comparing neoadjuvant setting treatment with standard treatment for advanced mullerian cancer, such as ovarian, tubal or peritoneal cancer. These prospective studies are expected to reveal the role of NAC for advanced müllerian cancer.