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Background: First line treatment of advanced ovarian cancer(OC)is accepted to be primary surgery(PS)followed by adjuvant platinum-based chemotherapy(P-CT).However,the EORTC55971 trial suggested neoadjuvant chemotherapy(NACT)is an alternative,showing increased optimal debulking rates and reduced surgical complications without detriment to survival.CHORUS(CRUK 07/009)is the 2nd phase Ⅲ randomized controlled trial to investigate timing of initial surgery in OC.Methods: Patients(pts)with clinical FIGO stage Ⅲ-Ⅳ OC(pelvic mass,extrapelvic metastases and CA125/CEA ratio.25)were randomized to standard treatment(PS followed by 6 cycles P-CT)or NACT(3 cycles P-CT either side of surgery).CHORUS was designed to demonstrate non-inferiority of NACT,excluding a 6%absolute detriment in 3yr survival from 50%expected with PS(1-sided alpha 10%).Primary outcome was overall survival(OS)and secondary outcomes were progression free survival(PFS),toxicity and quality of life.Results: 550 women(276 PS,274 NACT)were randomized from 74 centres(72 UK,2 NZ)between Mar 2004 and Aug 2010.Baseline characteristics were well balanced: median age 65yrs,median tumor size 80mm,25%FIGO stage Ⅳ,19%WHO PS 2.Median follow-up was 3yrs,410 pts have died.Treatment data are summarized in the Table.3yr survival in the control arm was 32%.Intention to treat analysis showed a median OS of 22.8 months for PS vs 24.5 months for NACT(hazard ratio(HR)0.87 in favor of NACT,80%CI 0.76 – 0.98)and median PFS of 10.2 vs 11.7 months(HR 0.91,0.81 – 1.02).OS results represent a 5%absolute benefit in 3yr survival for NACT to 37%and the upper 80%CI allows us to exclude a survival benefit for PS.Conclusions: NACT was associated with increased optimal debulking,less early mortality and similar survival in this poor prognosis group.CHORUS results are consistent with EORTC55971 and strengthen evidence that NACT is a viable alternative to PS.