How do you approach interval cytoreductive surgery in patients with epithelial ovarian cancer requiring 6 or more cycles of neoadjuvant chemotherapy?

I think this is a really hard question. It obviously depends on why they've gotten 6 cycles of neoadjuvant chemotherapy. If they had medical problems that delayed surgery, then an interval debulking procedure makes sense. If they have progressive disease, then they are unlikely to ever be a candidate for interval debulking surgery.

However, if they have had some response or stable disease that does not require radical surgery, I would consider a hysterectomy, bso, omentectomy (potentially minimally invasively if there is little enough disease) to attempt to give them some time without chemotherapy after their adjuvant treatment and to provide the standard of care treatment for ovarian cancer. If they would need a radical debulking at that po...