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Neo-adjuvant chemotherapy in stage IIIC potentially resectable epithelial ovarian cancer

机译：IIIC期可能会切除的上皮性卵巢癌的新辅助化疗

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I would like to comment on the recently (October 2016 issue of Gynecologic Oncology) published guideline for neoadjuvant chemotherapy (NACT) in newly diagnosed ovarian cancer and specifically with regards to potentially resectable disease (Recommendation 3.1) (Wright et al., 2016). The decision to proceed with NACT or primary surgery (PCS) in newly diagnosed stage IIIC disease should not be confused with the decision of whether surgery is at all appropriate in a given patient because of her general condition or comorbidities. This should be clarified first and be distinct from the decision of timing of cytoreductive surgery. The appropriateness of surgery may of course be modified if there is a progression during NACT (as Recommendation 7 of the guideline advocates) or conversely if an unexpected improvement of the clinical condition of the patient is obtained during palliative chemotherapy. Availability of the NACT option should not be an “excuse” for not operating on a potentially resectable patient because of other comorbidities that would increase her surgical complication risk or because of concerns of inexperienced surgeons that a primary debulking surgery would be more difficult. Instead the general status of the patient should weight in the decision of proceeding with NACT only if it is believed to be related to the burden of the cancer and patients that are expected to be technically more difficult should be referred to more experienced centers.
机译：我想评论一下最近出版的《妇科肿瘤学》（2016年10月号）关于新诊断的卵巢癌的新辅助化疗（NACT）指南，特别是关于潜在可切除疾病的指南（建议3.1）（Wright等，2016）。对于新诊断的IIIC期疾病，应继续进行NACT或原发手术（PCS）的决定不应与由于其一般情况或合并症而决定是否对特定患者进行手术完全合适。这应该首先阐明，并且与减细胞手术的时机决定不同。如果在NACT期间有进展（如指南的建议7），或者相反地，如果在姑息化疗期间患者的临床状况得到了意料不到的改善，则可以适当地改变手术的适当性。由于其他合并症会增加手术并发症的风险，或者由于经验不足的外科医生担心初次大型手术难度较大，因此NACT选件的使用不应成为不能对可能切除的患者进行手术的“借口”。取而代之的是，只有在认为NACT与癌症负担有关的情况下，才应权衡患者的总体状况，并且应该将技术上较困难的患者转诊给经验丰富的中心。

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