Abstract
Epithelial ovarian cancer has the highest morbidity of all gynecologic cancers in the USA. In 2006, it is estimated that 20,180 new cases will have been diagnosed and 15,310 women will have died from ovarian cancer. Most patients are diagnosed with advanced-stage disease (stage III and IV). The conventional initial management of the disease involves a combination of aggressive cytoreductive surgery followed by chemotherapy regimens that include a platinum and taxane drug. Retrospective reviews correlate survival with the size of the residual tumor at the end of the initial surgery. For patients who are poor surgical candidates and for those who are unlikely to be optimally surgically cytoreduced, treatment with chemotherapy prior to any surgery (i.e., neoadjuvant chemotherapy) has been proposed to increase the feasibility of the subsequent surgical debulking and to decrease perioperative morbidity. There is a lack of consensus in studies assessing survival outcomes after neoadjuvant chemotherapy. In stage IV disease, neoadjuvant chemotherapy may offer a survival advantage. This article will review the current standards of care for women with advanced ovarian cancer, including primary cytoreductive surgery and interval debulking surgery. It will focus on the role of neoadjuvant chemotherapy in managing advanced-stage epithelial ovarian cancer in the current literature.