Epithelial ovarian cancer is the sixth commonest cancer world-wide and is the commonest form of ovarian cancer (approximately 90% of ovarian cancers). Unfortunately most women with ovarian cancer (75%) present at a late stage when their disease has spread throughout the abdomen. This is because symptoms are vague, often occur only after the cancer has spread, and can be misdiagnosed as being caused by other benign conditions. The five-year survival for women with ovarian cancer is poor (approximately 30%).
Conventional treatment for ovarian cancer is to have surgery (laparotomy) to remove the womb, ovaries, the omentum (a fatty apron that hangs down from the stomach in the upper abdomen) and to sample the lymph nodes (glands) in the pelvis and abdomen. The intention of surgery is to stage the disease (assess where the cancer has spread to) and remove as much of the cancer as possible (debulking). However, since most women will have widespread disease, surgery is not normally curative and further treatment is necessary, in the form of chemotherapy. Chemotherapy for ovarian cancer uses platinum-based drugs (carboplatin and cisplatin) to treat any cancer cells that cannot be removed by surgery or are too small to be seen (microscopic disease).
Chemotherapy can be used before surgery (also called neoadjuvant chemotherapy) with the aim of shrinking the cancer and making it easier to remove all of the cancer. This approach has been used to treat other cancers (e.g. cancer of the cervix).
Currently there is no conclusive evidence from randomized control trials (RCTs) to suggest that neoadjuvant chemotherapy for ovarian cancer followed by surgery is better than conventional surgery then chemotherapy. Only one small RCT was found that compared platinum-based chemotherapy before surgery with chemotherapy after surgery. No difference in terms of survival was found between the two groups. However, this is likely to be because the trial included too few women to detect any small improvement or decrease in survival. Also the women in the pre-operative chemotherapy group received the chemotherapy directly into the arteries that supply the ovaries, after which the arteries were blocked off (embolized). This was not performed in the other group (primary surgery then chemotherapy), so it is not possible to say whether the reduced complications during surgery seen in the pre-operative chemotherapy group were due to the embolization or the neoadjuvant chemotherapy.
Three on-going trials were identified and it is hoped that these will answer the question in the future.