LAUSR

completed SCORPION study comparing NAC to primary surgery, clearly demonstrated that patient symptoms and quality of life were significantly better in the neoadjuvant chemotherapy arm.2 The author also suggests that the low optimal primary cytoreduction rate in the EORTC phase 3 Trial comparing primary NAC followed by interval surgery with primary cytoreductive surgery may have compromised the outcomes in this arm of the study. This trial specifically recruited patients with very bulky upper abdominal disease and 62% of patients had metastatic deposits of greater than 10 cm. A previous metaanalysis noted a median optimal cytoreduction rate of 32% in cohorts reporting primary cytoreduction to less than one cm residual tumour volume.3 The optimal cytoreduction rates in the EORTC study given the volume of disease is therefore comparable to previously reported cohorts. It is likely given the ageing population with a higher incidence of comorbidities, that neoadjuvant chemotherapy use will continue to increase as previously reported in this journal.4 We believe that based on current evidence, NAC is a valid, evidencebased standard of care for many patients with advanced ovarian cancer. The focus should now be on better identifying those patients who would benefit from primary cytoreductive surgery with low and acceptable morbidity.