NEOADJUVANT CHEMOTHERAPY FOR EPITHELIAL OVARIAN CANCER. MODERN METHODS AND PATIENTS SELECTION CRITERIA

Abstract

Ovarian cancer is the 3rd most common cancer among women with gynecological neoplasms in Russia, at the same time, it have the highest mortality rate among malignant tumors of the female reproductive system. Because ofvague clinical picture and the lack of effective methods for early detection and screening, more than 60% of cases are diagnosed at stage III-IV, after the spread of tumor beyond the pelvis. Standard treatment for this category of patients includes debulking surgery on the first stage, followed by adjuvant chemotherapy. The main predictor of the prognosis is the residualvolume of disease after debulking surgery. Nowadays, complete resection of all macroscopic disease is considered as optimal cytoreduction. Trying to perform surgical treatment in the optimal volume dictates the need for complex, multi-component operations, accompanied by significant postoperative morbidity and mortality. In addition, in many cases, resection of all macroscopic foci of the disease is technically impossible.The use of neoadjuvant chemotherapy is designed to reduce the incidence of postoperative complications and to achieve optimal cytoreduction in the maximum number of patients.After an analysis of literature the authors could make up aconclusion that the place of neoadjuvant chemotherapy in the treatment of advanced forms of ovarian cancer is still arguable. Based on data from clinical trials, the primary debulking surgery after the diagnosis is the best treatment for this category of patients. However, among patients with markers of unresectability according to the radiologic methods, as well as patients with poor performance status, that significantly increases the risk of surgery, use of neoadjuvant chemotherapy is a reasonable method of choice.

Keywords

• ovarian cancer
• neoadjuvant chemotherapy
• optimal debulking surgery