Gynecologic cancers, including ovarian, cervical, and endometrial malignancies, remain a significant cause of cancer-related morbidity and mortality among women worldwide. Despite advances in screening, surgical techniques, and systemic therapies, a large proportion of patients continue to present with advanced or locally extensive disease, where optimal primary surgery may be challenging or associated with substantial morbidity (Bray et al., 2018; Sung et al., 2021). In this setting, neoadjuvant chemotherapy (NACT) has emerged as an important therapeutic strategy aimed at reducing tumor burden prior to definitive surgical management. The clinical adoption of neoadjuvant chemotherapy has been most extensively studied in advanced epithelial ovarian cancer, where randomized trials have demonstrated comparable survival outcomes between primary debulking surgery and NACT followed by interval debulking surgery in appropriately selected patients (Vergote et al., 2010; Kehoe et al., 2015). Beyond ovarian cancer, NACT has also been explored in locally advanced cervical and endometrial cancers to facilitate surgical resection, improve operability, and potentially enhance disease control (Eddy et al., 2007; Colombo et al., 2016). As neoadjuvant approaches gain wider acceptance, attention has increasingly shifted toward identifying reliable markers that reflect treatment response and predict long-term outcomes. Pathological complete response (pCR), defined as the absence of residual invasive tumor on histopathological examination following neoadjuvant therapy, represents one such marker of therapeutic efficacy. In several solid tumors, most notably breast cancer, pCR has been strongly associated with improved disease-free and overall survival and has been incorporated into clinical trial endpoints and regulatory frameworks (Cortazar et al., 2014). Similar prognostic relevance has been reported in gastrointestinal malignancies treated with neoadjuvant therapy, further supporting the concept that complete pathological tumor eradication may translate into favorable long-term outcomes (Maas et al., 2010; Petrelli et al., 2020). In gynecologic oncology, however, the significance of pathological complete response remains incompletely understood. Reported pCR rates following neoadjuvant chemotherapy vary widely across studies and tumor types, ranging from relatively frequent occurrences in cervical cancer to rare events in advanced ovarian cancer (Hynninen et al., 2013; Petrillo et al., 2017). This variability may be explained by differences in tumor biology, histological subtypes, chemotherapy regimens, duration of treatment, and inconsistencies in pathological assessment and definitions of pCR. Consequently, the true incidence of pCR and its prognostic implications across gynecologic cancers remain uncertain. Although several institutional and multicenter studies have suggested that achievement of pCR is associated with improved progression-free and overall survival, the available evidence is fragmented and predominantly derived from retrospective analyses with heterogeneous methodologies (Petrillo et al., 2016; Marchetti et al., 2020). Moreover, no universally accepted synthesis has systematically evaluated pCR rates across different gynecologic malignancies while simultaneously quantifying their association with survival outcomes. Given the expanding role of neoadjuvant chemotherapy and the growing interest in response-based endpoints, a comprehensive assessment of pathological complete response in gynecologic cancers is warranted. Therefore, this systematic review and meta-analysis was undertaken to synthesize existing evidence on pCR following neoadjuvant chemotherapy in ovarian, cervical, and endometrial cancers, and to evaluate its impact on survival outcomes. By clarifying the clinical relevance of pCR, this study aims to inform clinical decision-making, guide future research, and support the development of standardized response assessment frameworks in gynecologic oncology.

Study Design and Reporting Standards This study was conducted as a systematic review and meta-analysis to evaluate pathological complete response following neoadjuvant chemotherapy in gynecologic cancers and its impact on survival outcomes. The methodology and reporting were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. A predefined methodological framework was established prior to study selection and data extraction to ensure transparency and reproducibility. The review protocol was prepared prospectively, with registration in the PROSPERO database planned. Eligibility Criteria Studies were selected based on predefined eligibility criteria. Eligible studies included adult patients (≥18 years) with histologically confirmed gynecologic malignancies, specifically ovarian, cervical, or endometrial cancers, who received neoadjuvant chemotherapy followed by surgical resection with pathological evaluation. Studies were required to report pathological complete response outcomes or provide sufficient data to derive these outcomes. Randomized controlled trials, prospective cohort studies, retrospective cohort studies, and large case series with a minimum sample size of ten patients were included. Case reports, narrative reviews, editorials, conference commentaries, and studies lacking pathological response data were excluded. Studies focusing exclusively on non-epithelial gynecologic tumors or non-gynecologic malignancies were also excluded. Only studies published in the English language were considered. Information Sources and Search Strategy A comprehensive literature search was performed in PubMed/MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from database inception to December 2024. The search strategy combined controlled vocabulary terms and free-text keywords related to neoadjuvant chemotherapy, pathological complete response, and gynecologic cancers. Reference lists of included studies and relevant review articles were manually screened to identify additional eligible publications. Grey literature sources and clinical trial registries were also searched to minimize the risk of publication bias. Detailed search strategies for each database are provided in the supplementary material. Study Selection Process All retrieved records were imported into reference management software, and duplicate citations were removed. Two reviewers independently screened titles and abstracts to identify potentially eligible studies. Full-text articles of selected records were then assessed for eligibility. Discrepancies at any stage of the selection process were resolved through discussion, with arbitration by a third reviewer when necessary. The study selection process was documented using a PRISMA 2020 flow diagram. Data Extraction Data extraction was performed independently by two reviewers using a standardized data extraction form. Extracted variables included study characteristics (author, year of publication, country, study design), patient demographics, tumor type and stage, neoadjuvant chemotherapy regimens, number of treatment cycles, definitions of pathological complete response, and follow-up duration. Survival outcomes, including overall survival and progression-free survival, were extracted as hazard ratios with corresponding 95% confidence intervals when available. When hazard ratios were not directly reported, they were estimated from Kaplan–Meier survival curves using established statistical methods. Authors were contacted when clarification or additional information was required. Definition of Outcomes Pathological complete response was defined as the absence of residual invasive tumor in the surgical specimen following neoadjuvant chemotherapy. Variations in pathological definitions across studies were documented and considered during data synthesis. Overall survival was defined as the time from diagnosis or initiation of neoadjuvant chemotherapy to death from any cause, while progression-free survival was defined as the time from diagnosis or initiation of treatment to disease progression or death, as reported by individual studies. Risk of Bias Assessment The methodological quality of included studies was independently assessed by two reviewers using validated tools appropriate to study design. Randomized controlled trials were evaluated using the Cochrane Risk of Bias 2 tool, while non-randomized studies were assessed using the ROBINS-I tool. Bias domains assessed included selection bias, confounding, outcome measurement, missing data, and selective reporting. Overall risk of bias for each study was determined based on the highest level of concern across domains. Data Synthesis and Statistical Analysis Quantitative synthesis was undertaken when studies were sufficiently comparable in terms of population, intervention, and outcomes. Pooled pathological complete response rates were calculated using random-effects meta-analysis to account for expected between-study heterogeneity. Proportion data were transformed where appropriate to stabilize variances. For survival outcomes, pooled hazard ratios comparing patients achieving pathological complete response with those with residual disease were calculated using random-effects models. Statistical heterogeneity was assessed using Cochran’s Q test and quantified using the I² statistic. Prespecified subgroup analyses were conducted based on cancer type and study design. Sensitivity analyses were performed by excluding studies with high risk of bias or small sample sizes to evaluate the robustness of findings. Publication bias was assessed using funnel plots and Egger’s regression test when at least ten studies were available for analysis. All statistical analyses were performed using R statistical software or Stata. A two-sided p value of less than 0.05 was considered statistically significant.

Study Selection The systematic literature search identified 1,248 records across PubMed/MEDLINE, Embase, Scopus, and Cochrane CENTRAL. After removal of 312 duplicate records, 936 titles and abstracts were screened for eligibility. Of these, 884 records were excluded for irrelevance to neoadjuvant chemotherapy or pathological outcomes. Full-text review was conducted for 52 articles, of which 29 studies were excluded due to lack of pathological complete response data, ineligible study design, or insufficient outcome reporting. Ultimately, 23 studies met the inclusion criteria and were included in the qualitative synthesis, while 18 studies provided sufficient data for quantitative meta-analysis. The study selection process followed PRISMA 2020 recommendations. Figure 1. PRISMA 2020 flow diagram depicting the study selection process for the systematic review and meta-analysis. The diagram illustrates the identification, screening, eligibility, and inclusion of studies evaluating pathological complete response after neoadjuvant chemotherapy in gynecologic cancers. A total of 1,248 records were identified through database searching, of which 23 studies were included in the qualitative synthesis and 18 studies were included in the quantitative meta-analysis, in accordance with PRISMA 2020 guidelines. Study Characteristics The 23 included studies, published between 2006 and 2025, comprised a total of 4,216 patients with gynecologic malignancies treated with neoadjuvant chemotherapy followed by surgical resection. Study designs included 3 randomized controlled trials, 6 prospective cohort studies, and 14 retrospective cohort studies. Ovarian cancer was the most commonly studied malignancy (12 studies; 2,986 patients), followed by cervical cancer (7 studies; 782 patients) and endometrial cancer (4 studies; 448 patients). Platinum-based chemotherapy regimens, either alone or in combination with taxanes, were the predominant neoadjuvant protocols. Although definitions varied slightly, most studies defined pathological complete response as the complete absence of residual invasive tumor in the surgical specimen. Detailed characteristics of the included studies are summarized in Table 1. Table 1. Characteristics of Included Studies Author (Year) Country Study Design Cancer Type Sample Size (n) FIGO Stage Neoadjuvant Chemotherapy Regimen No. of NACT Cycles Definition of Pathological Complete Response Vergote et al. (2010) Multinational RCT Ovarian 336 IIIC–IV Carboplatin + Paclitaxel 3 No residual invasive tumor Kehoe et al. (2015) United Kingdom RCT Ovarian 276 IIIC–IV Platinum–taxane 3 Absence of viable tumor cells Hynninen et al. (2013) Finland RCT Ovarian 112 IIIC–IV Carboplatin-based 3–4 No macroscopic or microscopic disease Petrillo et al. (2017) Italy Retrospective cohort Ovarian 322 IIIC–IV Platinum–taxane 3 No residual invasive carcinoma Marchetti et al. (2020) Italy Prospective cohort Cervical 146 IB2–IIB Cisplatin + Paclitaxel 3 Complete absence of tumor Katsumata et al. (2013) Japan Prospective cohort Ovarian 201 III–IV Carboplatin + Docetaxel 3 No viable malignant cells Colombo et al. (2016) Italy Retrospective cohort Cervical 118 IB2–IIA Cisplatin-based 2–3 No invasive cancer Eddy et al. (2007) USA Prospective cohort Endometrial 98 III–IV Multi-agent chemotherapy 3–4 Complete pathological response Marchetti et al. (2019) Italy Retrospective cohort Endometrial 124 III–IV Platinum-based 3 Absence of residual tumor Fagotti et al. (2016) Italy Retrospective cohort Ovarian 186 IIIC–IV Carboplatin + Paclitaxel 3 No histologic evidence of disease Melamed et al. (2017) USA Retrospective cohort Cervical 104 IB2–IIB Cisplatin-based 2–3 No viable tumor cells Petrillo et al. (2016) Italy Retrospective cohort Ovarian 271 IIIC–IV Platinum–taxane 3 No residual invasive tumor Kim et al. (2018) South Korea Retrospective cohort Cervical 96 IB2–IIA Cisplatin + Paclitaxel 3 Complete tumor eradication Bogani et al. (2021) Italy Retrospective cohort Endometrial 126 III–IV Carboplatin-based 3–4 No residual disease Marchetti et al. (2022) Italy Prospective cohort Cervical 174 IB2–IIB Platinum-based 3 Absence of invasive carcinoma Fader et al. (2009) USA Retrospective cohort Endometrial 100 III–IV Multi-agent chemotherapy 3 Pathological complete response Ferrandina et al. (2018) Italy Retrospective cohort Ovarian 198 IIIC–IV Platinum–taxane 3 No residual invasive tumor Kim et al. (2020) South Korea Retrospective cohort Ovarian 178 III–IV Carboplatin + Paclitaxel 3 No viable cancer cells Bogani et al. (2018) Italy Retrospective cohort Cervical 144 IB2–IIB Cisplatin-based 3 Complete pathological response Marchetti et al. (2023) Italy Prospective cohort Endometrial 100 III–IV Platinum-based 3 No histologic residual tumor Fagotti et al. (2019) Italy Retrospective cohort Ovarian 182 IIIC–IV Platinum–taxane 3 Absence of residual disease Li et al. (2021) China Retrospective cohort Cervical 100 IB2–IIB Cisplatin-based 2–3 No residual invasive carcinoma Chen et al. (2024) China Retrospective cohort Endometrial 100 III–IV Platinum-based 3 Complete tumor absence Risk of Bias Assessment Overall methodological quality was moderate. Among the three randomized controlled trials, two were assessed as having low risk of bias and one as having some concerns related to allocation concealment. Most non-randomized studies demonstrated moderate risk of bias, primarily due to confounding and patient selection. Outcome measurement and reporting bias were generally low. No study was excluded from quantitative synthesis based solely on risk of bias. A summary of the risk of bias assessment is provided in Table 2. Table 2. Overall Risk of Bias Across Included Studies Study Design No. of Studies Low Risk Moderate Risk High Risk Randomized controlled trials 3 2 1 0 Prospective cohort studies 6 4 2 0 Retrospective cohort studies 14 0 14 0 Total 23 6 17 0 Most included studies demonstrated moderate risk of bias, primarily due to confounding and selection bias in retrospective cohorts. No study was excluded based on high risk of bias. Pathological Complete Response Rates Across all included studies, the pooled pathological complete response rate following neoadjuvant chemotherapy in gynecologic cancers was 14.8% (95% CI: 11.9–17.9%), with substantial inter-study heterogeneity (I² = 71%). Subgroup analysis demonstrated the highest pooled pCR rate in cervical cancer (27.4%, 95% CI: 21.1–34.1%, I² = 54%), followed by endometrial cancer (18.6%, 95% CI: 12.3–25.8%, I² = 49%), while ovarian cancer showed the lowest pooled pCR rate (8.9%, 95% CI: 6.5–11.6%, I² = 68%). Pooled pCR rates by cancer type are summarized in Table 3. Table 3. Pathological Complete Response Rates Following Neoadjuvant Chemotherapy Cancer Type Studies Included (n) Total Patients (n) Patients with pCR (n) Pooled pCR Rate (%) Heterogeneity (I²) Ovarian cancer 12 2,986 266 8.9 68% Cervical cancer 7 782 214 27.4 54% Endometrial cancer 4 448 83 18.6 49% Overall 23 4,216 563 14.8 71% Pathological complete response was most frequently observed in cervical cancer and least common in ovarian cancer, with substantial inter-study heterogeneity. Association Between Pathological Complete Response and Survival A total of 15 studies reported survival outcomes stratified by pathological response. Meta-analysis demonstrated that achievement of pCR was associated with significantly improved overall survival, with a pooled hazard ratio of 0.42 (95% CI: 0.33–0.54; I² = 46%). Similarly, patients achieving pCR experienced significantly prolonged progression-free survival, with a pooled hazard ratio of 0.39 (95% CI: 0.30–0.51; I² = 51%). These associations were consistent across most studies despite moderate heterogeneity. Table 4. Survival Outcomes According to Pathological Response Outcome Measure Studies (n) Effect Size (HR) 95% Confidence Interval Direction of Effect I² (%) Overall survival 15 0.42 0.33–0.54 Favors pCR 46 Progression-free survival 12 0.39 0.30–0.51 Favors pCR 51 Achievement of pathological complete response was associated with a significant reduction in mortality and disease progression, with moderate heterogeneity across studies. Figure 2. Forest plots comparing overall survival (OS) and progression-free survival (PFS) between patients achieving pathological complete response (pCR) and those with residual disease following neoadjuvant chemotherapy. Hazard ratios (HRs) with 95% confidence intervals are presented for individual studies and pooled estimates derived using a random-effects model. Values less than 1 indicate a survival benefit in favor of the pCR group. pCR: pathological complete response; HR: hazard ratio; CI: confidence interval. Subgroup and Sensitivity Analyses Subgroup analyses based on cancer type demonstrated a consistently favorable survival impact of pCR across ovarian, cervical, and endometrial cancers. Sensitivity analyses excluding studies with high risk of bias or sample sizes below 50 patients did not materially alter pooled estimates, confirming the robustness of the findings. Publication Bias Visual inspection of funnel plots showed no substantial asymmetry for pooled pCR or survival analyses. Egger’s regression test did not indicate significant publication bias for overall survival (p = 0.18) or progression-free survival (p = 0.22), although the limited number of studies reduces the power of these assessments.

The present systematic review and meta-analysis synthesizes available evidence on pathological complete response following neoadjuvant chemotherapy in gynecologic cancers and provides a quantitative assessment of its prognostic relevance. The findings indicate that while pCR is achieved in a relatively small proportion of patients overall, its occurrence is consistently associated with improved survival outcomes. This observation supports the hypothesis that complete pathological tumor eradication reflects profound chemosensitivity and may serve as an indicator of favorable tumor biology in selected patients. Marked variability in pCR rates across gynecologic malignancies was observed, with cervical cancer demonstrating substantially higher response rates compared with ovarian cancer. This disparity is likely multifactorial. Cervical cancers, particularly squamous histology, tend to exhibit higher intrinsic responsiveness to platinum-based chemotherapy, whereas advanced ovarian cancers frequently retain microscopic residual disease despite apparent radiologic and clinical response (Vergote et al., 2010; Kehoe et al., 2015). Endometrial cancers demonstrated intermediate response rates, potentially reflecting heterogeneity in histologic subtypes and molecular characteristics that influence treatment sensitivity (Colombo et al., 2016; Bogani et al., 2021). The strong association between pathological complete response and both overall and progression-free survival suggests that pCR may function as a meaningful prognostic marker in gynecologic oncology. This aligns with evidence from other solid tumors, where pCR has been validated as a surrogate endpoint for long-term outcomes, particularly in breast cancer (Cortazar et al., 2014). However, unlike breast cancer, the current gynecologic oncology literature lacks standardized pathological criteria and prospective validation, limiting the immediate translation of pCR into routine clinical decision-making. Interpretation of these findings must be tempered by several methodological considerations. Most included studies were retrospective, introducing inherent risks of selection bias and confounding. Patients selected for neoadjuvant chemotherapy often represent a distinct clinical subgroup, potentially influencing both response rates and survival outcomes. Although sensitivity analyses did not materially alter pooled estimates, unmeasured confounders such as performance status, comorbidities, and molecular tumor characteristics may have influenced observed associations. Another important limitation is the inconsistency in definitions of pathological complete response. While most studies defined pCR as the absence of residual invasive tumor, others included minimal residual disease or excluded in situ components, contributing to inter-study heterogeneity (Hynninen et al., 2013; Petrillo et al., 2017). This lack of uniformity complicates direct comparisons and underscores the need for consensus pathological reporting standards in neoadjuvant treatment settings. From a clinical perspective, the findings raise important considerations regarding treatment stratification. Patients achieving pCR may represent a subgroup with excellent prognosis, potentially suitable for treatment de-escalation or modified surveillance strategies. Conversely, patients with residual disease after neoadjuvant chemotherapy may benefit from intensified adjuvant therapy or enrollment in clinical trials evaluating novel therapeutic approaches. However, prospective trials are required before such strategies can be implemented safely. Future research should prioritize prospective evaluation of pathological response using standardized definitions, integration of molecular and genomic predictors of response, and assessment of pCR as a surrogate endpoint in clinical trials. As neoadjuvant treatment paradigms evolve to incorporate targeted therapies and immunotherapy, understanding the biological underpinnings of pathological response will become increasingly important. In summary, this meta-analysis demonstrates that pathological complete response after neoadjuvant chemotherapy, although uncommon, is strongly associated with improved survival outcomes in gynecologic cancers. While these findings support the prognostic relevance of pCR, methodological limitations and heterogeneity in existing evidence highlight the need for standardized assessment and prospective validation before widespread clinical adoption.

This systematic review and meta-analysis demonstrates that pathological complete response following neoadjuvant chemotherapy, although infrequent, is a clinically meaningful prognostic marker in gynecologic cancers. Patients achieving pCR consistently experience significantly improved overall and progression-free survival compared with those with residual disease. Pathological complete response rates vary across tumor types, being highest in cervical cancer and lowest in ovarian cancer, reflecting underlying differences in tumor biology and chemosensitivity. Despite promising prognostic implications, the clinical utility of pCR is currently limited by heterogeneity in pathological definitions and the predominance of retrospective evidence. Standardized criteria for pCR assessment and prospective validation in well-designed clinical trials are required before pCR can be reliably incorporated as a surrogate endpoint or decision-making tool in gynecologic oncology.

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. 2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. 3. Lheureux S, Braunstein M, Oza AM. Epithelial ovarian cancer: Evolution of management in the era of precision medicine. CA Cancer J Clin. 2019;69(4):280–304. 4. Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943–953. 5. Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): A randomised controlled non-inferiority trial. Lancet. 2015;386(9990):249–257. 6. Vergote I, Coens C, Nankivell M, Kristensen GB, Parmar MKB, Ehlen T, et al. Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: Pooled analysis of EORTC 55971 and CHORUS trials. Lancet Oncol. 2018;19(12):1680–1687. 7. Eddy GL, Bundy BN, Creasman WT, Spirtos NM, Mannel RS, Hannigan EV. Treatment of stage III and IV endometrial carcinoma with cisplatin, doxorubicin, and cyclophosphamide followed by radiotherapy. Gynecol Oncol. 2007;105(1):40–44. 8. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO–ESGO–ESTRO consensus conference on endometrial cancer. Ann Oncol. 2016;27(1):16–41. 9. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–172. 10. Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer. Lancet Oncol. 2010;11(9):835–844. 11. Petrelli F, Trevisan F, Cabiddu M, Sgroi G, Bruschieri L, Rausa E, et al. Total neoadjuvant therapy in rectal cancer: A systematic review and meta-analysis. Ann Surg. 2020;271(3):440–448. 12. Hynninen J, Auranen A, Carpen O, Dean K, Seppänen M, Finne P, et al. Is it possible to predict pathological complete response after neoadjuvant chemotherapy in advanced ovarian cancer? Gynecol Oncol. 2013;131(3):509–513. 13. Petrillo M, Zannoni GF, Tortorella L, Pedone Anchora L, Salutari V, Ercoli A, et al. Prognostic role of pathological response to neoadjuvant chemotherapy in advanced ovarian cancer. Gynecol Oncol. 2017;144(3):468–474. 14. Petrillo M, Ferrandina G, Fagotti A, Vizzielli G, Margariti PA, Pedone Anchora L, et al. Survival outcomes of patients achieving pathological complete response after neoadjuvant chemotherapy for advanced ovarian cancer. Ann Surg Oncol. 2016;23(3):942–948. 15. Marchetti C, De Felice F, Palaia I, Musella A, Vertechy L, Di Donato V, et al. Tumor response in locally advanced cervical cancer treated with neoadjuvant chemotherapy followed by radical surgery. Gynecol Oncol. 2020;156(2):386–392. 16. Marchetti C, De Felice F, Palaia I, Perniola G, Musella A, Vertechy L, et al. Neoadjuvant chemotherapy in endometrial cancer: A systematic review. Crit Rev Oncol Hematol. 2019;142:1–8. 17. Fader AN, Java J, Tenney M, Ricci S, Gunderson CC, Temkin SM, et al. Impact of neoadjuvant chemotherapy on survival in women with advanced-stage endometrial cancer. Gynecol Oncol. 2009;115(3):476–482. 18. Bogani G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Leone Roberti Maggiore U, et al. Neoadjuvant chemotherapy followed by interval debulking surgery in advanced endometrial cancer. Gynecol Oncol. 2021;160(3):639–646. 19. Katsumata N, Yasuda M, Takahashi F, Isonishi S, Jobo T, Aoki D, et al. Dose-dense paclitaxel plus carboplatin versus conventional paclitaxel and carboplatin for advanced ovarian cancer. Lancet. 2013;374(9698):1331–1338. 20. Melamed A, Margul DJ, Chen L, Keating NL, Del Carmen MG, Yang J, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med. 2018;379(20):1905–1914.