1. Introduction: The Evolution of Ovarian Cancer Care
Ovarian cancer remains a formidable clinical challenge, primarily because the lack of effective screening tools often results in diagnosis at advanced stages (FIGO Stage III-IV). Historically, Primary Cytoreductive Surgery (PCS) was the undisputed cornerstone of care. However, the 2025 ASCO guideline update reflects a significant paradigm shift: in the United States, there has been a substantial decline in PCS and a corresponding rise in Neoadjuvant Chemotherapy (NACT) followed by Interval Cytoreductive Surgery (ICS), which is now the most common upfront strategy.
Improving outcomes in this high-stakes environment requires more than a single intervention; it demands a sophisticated, multimodal treatment strategy that balances aggressive surgical intent with precision systemic therapy. This update provides an evidence-based framework for navigating the critical decision between PCS and NACT to optimize patient survival and quality of life.