Interval debulking surgery: An alternative for primary surgical debulking?

Retrospective analyses suggest that a subgroup of patients with Stage III a nd IV ovarian carcinoma can be treated with neo-adjuvant chemotherapy follo wed by interval debulking surgery. The absolute indications for neo-adjuvan t chemotherapy appear to be Stage IV disease (excluding pleural fluid) or m etastases of more than 1 g at sites where resection is impossible, In patie nts with an estimated total metastatic tumor load of >100 g, the presence o f at least two of the following relative indications for neo-adjuvant chemo therapy are considered to be necessary: 1) uncountable (>100) peritoneal me tastases, 2) estimated metastatic tumor load of >1000 g, 3) presence of lar ge (>10 g) peritoneal metastatic plaques, 4) large volume ascites, and 5) W orld Health Organization (WHO) status II or III. Interval debulking surgery in patients with suboptimal primary debulking surgery has been proven effe ctive in increasing overall survival and progression-free survival in a lar ge prospective, randomized trial of the European Organization for Research and Treatment of Cancer (EORTC). The strategy of neo-adjuvant chemotherapy, followed by interval debulking surgery, should be confirmed in a prospecti ve randomized trial. The EORTC 55971 trial is currently addressing this iss ue. We will review the studies on primary chemotherapy, interval debulking surgery, and the indications for primary chemotherapy followed by interval debulking surgery, and ongoing trials. Semin. Surg. Oncol. 19:49-53, 2000. (C) 2000 Wiley-Liss, Inc.