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Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction

Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patient...

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Autores principales: Cummings, Mackenzie, Nicolais, Olivia, Shahin, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9026414/
https://www.ncbi.nlm.nih.gov/pubmed/35454036
http://dx.doi.org/10.3390/diagnostics12040988
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author Cummings, Mackenzie
Nicolais, Olivia
Shahin, Mark
author_facet Cummings, Mackenzie
Nicolais, Olivia
Shahin, Mark
author_sort Cummings, Mackenzie
collection PubMed
description Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical candidates. After publication of EORTC 55971, the first randomized trial demonstrating non-inferiority of NACT followed by interval debulking surgery, NACT was considered in a wider breadth of patients. Since EORTC 55971, 3 randomized trials—CHORUS, JCOG0602, and SCORPION—have studied NACT versus PDS. While CHORUS supported EORTC 55971, JCOG0602 failed to demonstrate non-inferiority and SCORPION failed to demonstrate superiority of NACT. Despite conflicting data, a subset of patients would benefit from NACT while preserving survival including poor surgical candidates and inoperable disease. Further randomized trials are needed to assess the role of NACT.
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spelling pubmed-90264142022-04-23 Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction Cummings, Mackenzie Nicolais, Olivia Shahin, Mark Diagnostics (Basel) Review Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical candidates. After publication of EORTC 55971, the first randomized trial demonstrating non-inferiority of NACT followed by interval debulking surgery, NACT was considered in a wider breadth of patients. Since EORTC 55971, 3 randomized trials—CHORUS, JCOG0602, and SCORPION—have studied NACT versus PDS. While CHORUS supported EORTC 55971, JCOG0602 failed to demonstrate non-inferiority and SCORPION failed to demonstrate superiority of NACT. Despite conflicting data, a subset of patients would benefit from NACT while preserving survival including poor surgical candidates and inoperable disease. Further randomized trials are needed to assess the role of NACT. MDPI 2022-04-14 /pmc/articles/PMC9026414/ /pubmed/35454036 http://dx.doi.org/10.3390/diagnostics12040988 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Cummings, Mackenzie
Nicolais, Olivia
Shahin, Mark
Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction
title Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction
title_full Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction
title_fullStr Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction
title_full_unstemmed Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction
title_short Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction
title_sort surgery in advanced ovary cancer: primary versus interval cytoreduction
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9026414/
https://www.ncbi.nlm.nih.gov/pubmed/35454036
http://dx.doi.org/10.3390/diagnostics12040988
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