Management of Advanced Ovarian Cancer: A Brief Insight into the Role of Neoadjuvant Chemotherapy Followed By Interval Debulking Surgery
Sunita Thapa, Lilian Onwanga, Cheng-Wen Jun*
Jiangsu Women's and Children Health Hospital, W&C Branch Hospital of Jiangsu Province Hospital Affiliated to Nanjing Medical University, 368 Jiang Dong Road, Nanjing, China
Ovarian cancer is a fatal gynecologic cancer and ranks as the seventh most common cancer in women worldwide. It can affect women of all ages but is typically seen in between 55-64 years. With no specific early signs and symptoms, most patients are diagnosed at a late stage and thus, associated with high mortality. The diagnosis is only confirmed pathologically following surgery or by cytological evaluation. Surgery accompanied by adjuvant chemotherapy has been the standard approach for managing ovarian cancer. However, the majority of the patients cannot undergo primary debulking due to old age, poor quality of life, huge tumor burden and ascites. Thus, over the recent years, neoadjuvant chemotherapy (NACT) accompanied by interval debulking surgery (IDS) has shown incredible results in the management of advanced ovarian cancer, especially in patients unfit for undergoing primary debulking. The progression-free survival between primary debulking surgery and NACT accompanied by IDS were reported almost similar with a lesser rate of perioperative morbidity and mortality reported in patients under NACT treatment regimen. Residual disease is a significant factor determining the patient's prognosis in ovarian cancer and various studies have reported that NACT treatment regimen helps to achieve a better rate of optimal cytoreduction and hence improves the quality of life. Proper selection of patients would be advantageous in individualizing the treatment regimen, which would help in improving patient's prognosis. Although there are strong evidences advocating for NACT treatment regimen, still some doubts exist and further research is still warranted.