Optimizing the primary treatment of patients with advanced ovarian cancer
In this article we analyzed the issues of optimizing the upfront debulking surgery for patients with advanced ovarian cancer. We reviewed the recent evidence highlighting the actual concerns of using neoadjuvant chemotherapy aiming to reduce the tumor burden and enhance the probability of optimal cytoreduction; the rates of complete and optimal cytoreduction. From the up-to-date point of view we designated the pros and cons of upfront and neoadjuvant chemotherapy, the major disadvantages of the only head-to-head comparison study of these approaches. Outlined the role lymphodissection and extended surgery for advanced ovarian cancer, including performance of small and large bowel, liver, spleen, peritoneum and diaphragm resections. We analyzed the existing risk factors of and prognostic models predicting the probability of optimal cytoreduction which allows the oncologists to select patients which will benefit from neoadjuvant chemotherapy and interval cytoreduction.