Dr. Hoffman on Primary Debulking Versus Neoadjuvant Chemotherapy in Ovarian Cancer

Mitchel Hoffman, MD, gynecologic oncologist, Moffitt Cancer Center, discusses eligibility criteria for primary debulking surgery versus neoadjuvant chemotherapy in advanced ovarian cancer.

Some patients are clearly not fit for surgery, says Hoffman—for example, those with cancer that extends through the belly cavity. Moreover, patients whose intestinal function starts to decline are not fit for surgery. Furthermore, some patients have deep vein thrombosis, pulmonary embolism, or a variety of other symptoms that would prohibit them from undergoing surgery. Some patients are selected for surgery by doing CT scans and biopsies, adds Hoffman. Others may undergo laparoscopic surgery to determine whether surgery is recommended.

Conversely, if the CT scan shows extensive liver metastases, neoadjuvant chemotherapy is given. Others with a high burden of disease may only receive chemotherapy. Additionally, there are patients, who after receiving 3 cycles of chemotherapy, are evaluated to determine whether debulking is recommended, concludes Hoffman.