Introduction/Background*Primary Cytoreductive surgery (CRS) followed by systemic chemotherapy is the standard management up to stage IIIB Epithelial ovarian cancer (EOC). The controversy starts with stage IIIC onwards ovarian cancer where differences in opinion has been noticed regarding initial approach towards these advanced cases. Incidence wise more than two third EOC patients present in advanced stages i.e., stage IIIC and beyond. As the standard treatment is primary cytoreductive surgery but it always challenges a surgeon to perform surgery in these locally advanced EOC. Therefore, the need for neoadjuvant chemotherapy (NACT) had been noticed in some selected cases. We share our outcomes as chemotherapy first or surgery first as the modality of treatment in advanced EOC.

Methodology A total of 200 patients of advanced epithelial ovarian cancer (EOC) were analyzed from 2012 to 2017 from a prospectively maintained ovarian cancer database. More than 90% patients were stage III and beyond. Overall survival was calculated in both the groups and cox multivariate analysis was performed for degree of cytoreduction and response to NACT.

Result(s)*Out of 200 included patients of advanced EOC– primary CRS was performed in 95 patients (47.5%) and Interval CRS after 3 to 6 cycles of NACT in 105 patients (52.5%). After median follow up of 35months, 5-year overall survival in upfront CRS group was 53.7% (CI= 0.405-0.651) and OS in NACT group was 42.2% (CI=0.318-0.522). Among upfront CRS group, optimal cytoreduction could be achieved in 66(72%) patients and in NACT group, optimal cytoreduction was achieved in 82(78%). In our tertiary care center, we offered HIPEC after CRS in both the groups where we could have achieved optimal cytoreduction.

Conclusion*Primary CRS is the standard treatment modality in advanced stages of EOC. However, in certain cohort of patient, we preferred NACT over upfront CRS. Identifying that group is challenging but feasible. Proper selection of patient is the ultimate key for reasonable outcomes.