RESUMO
Primary debulking surgery followed by chemotherapy is the current treatment for [FIGO] stage IIIC ovarian carcinoma. However, patients with unresectable bulky tumors time unable to receive standard treatment and thus have a poor prognosis. Neoadjuvant chemotherapy could induce downstaging and thus improve operability by Interval debulking. The purpose of this study is to report our experience with primary debulking in advanced ovarian carcinoma and the role of neoadjuvant chemotherapy [NAC] and interval debulking [ID] in primary unresectable tumors. One hundred patients with FIGO stage IIIC ovarian carcinoma were prospectively treated at the National Cancer Institute [NCI], Cairo University between February 2000 and November 2003. All patients underwent surgical staging to evaluate tumor resectability. Resectable patients were treated by primary dehulking [PD] followed by 6 cycles of adjuvant chemotherapy. Unresectable patients were treated by NAC followed by ID and adjuvant chemotherapy. The two groups were investigated and compared with respect to tumor resection rates, magnitude of resection blood transfusions duration of surgery, postoperative hospital staty morbidity of .surgery and survival. Of 100 patients, 48 patients' were resectable with 34 [71%] patients achieving optimal cytoreduction Of the 52 patients who received NAC, ID was pemformed in 44 patients. Optimal cytoreduction was achieved in 35 patients [67%]. The rates of additional resections and morbidity were significantly reduced in ID group. The difference in the overall survival between the two groups was not statistically significant [p = 0. 712]. NAC followed by ID is feasible and can convert a high percentage of patients with unresectable tumors into patients free of macroscopic [disease. The magnitude of resections and morbidity are reduce after NAC and ID surgery. ID offers survival rates comparable to PD in advanced ovarian cancer. NAC and ID is an alternative treatmnent for patients with advanced unresectable ovarian cancer in whom the chamice of optimnal cytoreduction is low