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Barriers to Primary Debulking Surgery for Advanced Ovarian Cancer in Latin America
  1. Eduardo Paulino, MD*,,,
  2. Angelica Nogueira Rodrigues, MD, PhD,§,
  3. Kathrin Strasser-Weippl, MD,
  4. Jessica St. Louis, BA,,
  5. Alexandra Bukowski, BA, and
  6. Paul E. Goss, MD, PhD,,#
  1. *Brazilian National Cancer Institute;
  2. Grupo COI, Rio de Janiero, Brazil;
  3. Global Cancer Institute, Boston, MA;
  4. §Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil;
  5. Wilheminen Hospital, Vienna Austria;
  6. MGH-Avon Global Cancer Program; and
  7. #Harvard Medical School, Boston, MA.
  1. Address correspondence and reprint requests to Paul E. Goss, Massachusetts General Hospital Cancer Center, Lawrence House, LRH-302, 55 Fruit St, Boston, MA 02114. E-mail:


Abstract Ovarian cancer is gynecologic tumor with particularly high mortality because it is usually diagnosed in advanced stages. In Latin America and the Caribbean, it is the eighth most common malignancy in women, with an estimated 18,000 new cases and 11,500 deaths annually. Standard of care for women diagnosed with advanced ovarian cancer (AOC) is primary cytoreductive surgery followed by systemic chemotherapy using a combination of paclitaxel plus carboplatin. To pursue upfront surgery, highly specialized and well-trained gynecologic oncologists are required, in addition with well-equipped hospitals. Neoadjuvant chemotherapy (NACT) has been gaining greater acceptance in the past decade for patients with AOC. Two phase III randomized clinical trials have demonstrated that NACT is noninferior to primary cytoreductive surgery for women with stages III and IV epithelial ovarian cancer, and since publication of these results, NACT is more commonly used. Apart from medical reasons of inoperability and unresectability, there may be nonmedical barriers to upfront debulking surgery in clinical practice. These barriers include inadequate expertise of the surgeon, inadequate resources, and/or barriers to access. The aim of this article was to discuss patterns of care and barriers to upfront ovarian debulking surgery, as well as a possible shift toward overuse of NACT as the primary approach for patients with AOC (stages III and IV) in Latin America.

  • Ovarian cancer
  • Debulking surgery
  • Neoadjuvant chemotherapy
  • OC - ovarian cancer
  • LA - Latin America
  • AOC - advanced ovarian cancer
  • NACT - neoadjuvant chemotherapy

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  • E.P., A.N.R., J.S., A.B., and P.E.G. are supported in part by the Avon Breast Cancer Crusade. This funding source had no role in the planning or writing of this article.

  • The authors declare no conflicts of interest.