Primary versus interval debulking surgery in the management of ovarian cancer patients, current data summary

Abstract

Primary versus interval debulking surgery in the management of ovarian cancer patients, current data summary Victoria Psomiadou1,*, Alexandros Fotiou1 , Christos Iavazzo1 1Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 18537 Piraeus, Greece *Correspondence: psomiadouvictoria@gmail.com (Victoria Psomiadou) Academic Editor: Giuseppe Ricci Submitted: 1 December 2021 Revised: 13 January 2022 Accepted: 22 January 2022 Published: 18 April 2022 Abstract Objective: Optimal management of ovarian cancer patients have been investigated by several centers and have been discussed in a great number of published articles. Aim of this article is the review of current data regarding this lethal malignancy treatment. Moreover, we discuss the ongoing trials regarding primary or interval cytoreductive surgery after neoadjuvant chemotherapy. Mechanism: We reviewed the relevant literature regarding ovarian cancer treatment via primary debulking surgery (PDS) as well as neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Findings in Brief: Our findings suggest that Neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) are alternative treatments for advanced-stage ovarian cancer patients where optimal debulking surgery is considered unfeasible, while some studies indicate that NACT/IDS offer similar oncological outcomes with fewer postoperative complications. The prediction of optimal debulking probability can be evaluated by CA-125 level ≥500 U/mL, performance status ≥2, suprarenal paraaortic or supradiaphragmatic nodes >1 cm, Porta hepatis disease, diffuse serosal bowel carcinomatosis, bowel mesenteric involvement or a PIV score ≥8 if a laparoscopy is performed. Conclusions: Regarding the management of advanced ovarian cancer patientswho receive neoadjuvant interval debulking surgery seems to be as efficacient as primary cytoreduction. The patients that are more eligible and could benefit from this treatment strategy should be specified through larger, double-blind randomized control trials. Keywords: ovarian cancer; primary debulking surgery; neoadjuvant chemotherapy; interval debulking surgery; optimal cytoreduction