Introduction

Surgery and chemotherapy are the major contributors to the management of patients with advanced epithelial ovarian cancer. Most clinicians accept that when optimal debulking seems likely cytoreductive surgery should be performed first ⁽¹⁾. However, when doubt exists about successful debulking the use of chemotherapy before such surgery (neoadjuvant chemotherapy) could be a reasonable alternative ⁽²⁾. Several nonrandomized studies in the past have suggested that a) survival might not be different with upfront chemotherapy followed by interval debulking surgery when compared to the standard approach, b) optimal surgical cytoreduction is more likely to be achieved after administration of chemotherapy, and c) this alternative approach might induce less morbidity ^(3-6). In order to verify the conceptual advantages of chemical versus surgical upfront debulking a prospective randomized phase III trial (protocol 55971) has been initiated within the EORTC Gynecologic Cancer Group, which is presently ongoing in cooperation with several European and non-European cooperative groups (Intergroup trial). The study is expected to close in 2005 with a target accrual of 704 patients.