Malignant ovarian carcinoma is the leading cause of death among gynecological cancers. Most of these cases are diagnosed at an advanced stage. Traditionally the treatment of advanced ovarian cancer is based on primary surgery, debulking the tumor to minimal volume, followed by chemotherapy. Numerous trials have proven that the residual tumor volume has the greatest impact on patient prognosis. The use of neoadjuvant chemotherapy was proposed in an effort to increase the number of patients who will benefit from optimal debulking, as well as minimize the mortality and morbidity associated with major surgery. This review will discuss whether, and in which cases, neoadjuvant chemotherapy is an appropriate equivalent to primary surgery.
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