Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in phase III randomized trial: JCOG0602.

Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

“…1,2,4,5 At the time that the recommendations were being formulated, two of these trials had been published 1,2 and two were available only as oral presentations from national meetings. 4,5 All four trials enrolled women with stage IIIC or IV epithelial ovarian cancer, but two studies also included women with substage IIIA and IIIb disease, 2,5 and the specific requirements regarding biopsy, imaging, serum, or staging laparoscopy findings varied by study (Table 1). The two published trials provided results for overall and progression-free survival as well as perioperative morbidity and mortality.…”

“…5 Three hundred and one women were randomly assigned to either PCS followed by eight cycles of carboplatin and paclitaxel or to NACT with four cycles of carboplatin and paclitaxel followed by interval cytoreduction, followed by four more cycles of paclitaxel and carboplatin. Operative time during surgery was longer in the NACT arm than in the PCS arm, but patients in the NACT arm experienced less blood loss and ascites during or after surgery, and were less likely to experience a grade 3 or grade 4 nonhematologic adverse events after surgery (Table 1).…”

The shift toward neo‐adjuvant chemotherapy and interval debulking surgery for management of advanced ovarian and related cancers in a population‐based setting: Impact on clinical outcomes

“…Typically this means three cycles of chemotherapy prior to a planned surgical debulking, so‐called interval debulking surgery (IDS), followed by three further cycles of chemotherapy. There is now evidence from four phase III clinical trials that demonstrate that NACT+IDS is non‐inferior to PDS with respect to progression‐free survival (PFS) and overall survival (OS), but is associated with less peri‐operative morbidity and mortality . The Society of Gynecologic Oncology (SGO) and the American Society of Clinical Oncology (ASCO) have now published a practice guideline which recommends that women with advanced stage epithelial ovarian cancer who are fit for PDS, and with potentially resectable disease, may receive either NACT+IDS or PDS.…”

Neoadjuvant chemotherapy in gynaecological cancers – Implications for staging

“…The frequency of bowel or organ resection was lower in the NACT arm (p < 0.01), and operative morbidity, for example, blood/ascites loss (p < 0.01) and albumin transfusion (p < 0.01) were lower in the NACT arm. The authors concluded that NACT is less invasive compared to the PDS arm; survival data are likely to be mature in the year 2016 [12].…”