[Ovarian cancer].

Primary aggressive cyto-reduction followed by adjuvant chemotherapy has so far been the standard treatment modality for advanced ovarian cancer. However, as cisplatin-containing regimens have been shown to generate high efficacy rates, a new modality involving extirpation of the tumor after chemotherapy, rather than surgery as the first treatment, has become available for patients with stage III or IV ovarian cancer in whom tumor cells may remain after surgery. In our examination of 56 cases, higher efficacy rates, higher tumor-debulking rates, lower frequency of extended surgery and longer median survival time were obtained with preoperative chemotherapy in comparison with postoperative chemotherapy. These results were almost equivalent to those shown in the recent reports on preoperative chemotherapy for ovarian cancer: the efficacy rates have exceeded 80% against ovarian cancers except for mucinous adenocarcinoma and clear cell adenocarcinoma (70% of all ovarian cancers). In addition, preoperative chemotherapy has an advantage over postoperative chemotherapy in that the higher debulking rate may result in an improved quality of life. Moreover, the preoperative chemotherapy per se can be the best sensitivity testing, since chemotherapeutic effects can be determined during the following surgery. However, a large randomized trial is needed to definitely confirm the higher efficacy of preoperative chemotherapy over postoperative chemotherapy. Thus, it is considered that intensive induction chemotherapy followed by aggressive cyto-reduction can produce optimal cyto-reduction, which seems to offer a good prognosis. Thus, it should be the standard treatment modality for advanced ovarian cancer.