Feasibility evaluation for selection of neoadjuvant chemotherapy before cytoreduction of advanced ovarian carcinoma

Abstract

Ovarian carcinoma is one of three gynecological neoplasms. It typically develops as an insidious disease, with few warning signs or symptoms, because the ovary is situated at a deep part of the pelvic cavity. Advanced ovarian carcinoma (AOC) is highly malignant, so the prognosis of the patients is poor. Initial debulking surgery, followed by chemotherapy, is currently the main therapeutic choice for AOC. During operations, efforts should be made to excise the tumor and minimize the residual lesion, so as to achieve the optimal cytoreduction and improve the prognosis. As a feasible therapeutic regimen for the patients with primary unresectable AOC, neoadjuvant chemotherapy can improve the surgical condition and can increase the optimality of cytoreduction. It is important therefore to evaluate the feasibility of surgical treatment and make a proper selection of the primary treatment plan and neoadjuvant chemotherapy, so as to enhance the optimality of surgery and to avoid unnecessary exploratory laparotomy. At present, methods of feasibility evaluation for optimal cytoreduction of AOC are as follows: 1) radiography, i.e., CT, PET and MRI scanning; 2) CA-125 value; 3) laparoscopic exploration; 4) other tumor markers such as p53. However, any method lacks the ability to cover all the predicting factors influencing the outcome of cytoreduction, and to evaluate the surgery across the board. Searching for new methods and combining two or more procedures to evaluate the feasibility of cytoreduction may increase the optimality, reduce the residual focus, prolong survival time and improve the prognosis. In this study, recent advances in evaluation of the feasibility for optimal cytoreduction and the selection of neoadjuvant chemotherapeutic regimens were reviewed.