NACT should be used in women unfit for PDS or those with truly unresectable disease, not just older women. We believe the real question of this debate is how do we safely maximize the number of women ≥75 who are treated with PDS with an optimal resection resulting in the longest survival, while identifying vulnerable women in whom the morbidity of PDS is too great and thus NACT is the better approach. Multiple objective and easy to use tools have been developed to assess a patient’s functional status, something that is rarely represented by chronologic age. We must not forget that clinical trials commonly either do not assess functional status or exclude older women, and the number of trials focusing on the older population is low. An all or nothing approach is never the best answer, especially in the older, commonly more vulnerable, population.