Ignace Vergote, MD, PhD

Primary debulking surgery by a gynecologic oncologist remains thestandard of care in advanced ovarian cancer. Optimal debulking surgeryshould be defined as no residual tumor load. In retrospective analyses,neoadjuvant chemotherapy followed by interval debulking surgerydoes not seem to worsen prognosis compared to primary debulking surgeryfollowed by chemotherapy. However, we will have to wait for theresults of future randomized trials to know whether neoadjuvant chemotherapyfollowed by interval debulking surgery is as good as primarydebulking surgery in stage IIIC and IV patients. Interval debulking isdefined as an operation performed after a short course of induction chemotherapy.Based on the randomized European Organization for Researchand Treatment of Cancer–Gynecological Cancer Group (EORTC-GCG)trial, interval debulking by an experienced surgeon improves survival insome patients who did not undergo optimal primary debulking surgery.Based on Gynecologic Oncology Group (GOG) 152 data, intervaldebulking surgery does not seem to be indicated in patients who underwentprimarily a maximal surgical effort by a gynecologic oncologist.Open laparoscopy is probably the most valuable tool for evaluating theoperability primarily or at the time of interval debulking surgery.

In this issue of ONCOLOGY, Sonodaprovides a systematic reviewof the management of early ovariancancer. The author rightfully concludesthat comprehensive surgicalstaging should be performed in thesepatients and that, based on severalEuropean randomized studies, patientswith high-risk early ovarian cancershould be treated with adjuvant platinum-based chemotherapy. Importantquestions remain, however, including:How should high-risk early ovariancancer be defined? and Is there a needfor adjuvant chemotherapy in patientswho have undergone comprehensivesurgical staging?