Contemporary considerations for neoadjuvant chemotherapy in primary ovarian cancer.

Surgery is essential for the successful treatment of patients with advanced ovarian cancer. Recent reports have raised questions about the best time to perform surgery with regard to administering chemotherapy. A prospective randomized clinical trial comparing neoadjuvant chemotherapy (ie, platinum-based chemotherapy before attempting cytoreductive surgery) and conventional treatment (ie, aggressive cytoreductive surgery followed by platinum-based chemotherapy) demonstrated no difference in progression-free and overall survival between the two treatment groups. The trial demonstrated the need for optimum surgical cytoreduction regardless of whether surgery is performed before or after neoadjuvant chemotherapy. As the postoperative morbidity and mortality was lower in the neoadjuvant treatment group, neoadjuvant chemotherapy should be considered a standard treatment for women with advanced ovarian cancer, particularly those unlikely to be surgically cytoreduced to no residual tumor. This article reviews contemporary considerations in the use of neoadjuvant chemotherapy in the treatment of primary ovarian cancer.