Advanced Ovarian Cancer

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Key Points Î Nearly 75% of women with ovarian cancer are diagnosed with advanced stage disease (International Federation of Gynecology and Obstetrics [FIGO] IIIC or IV) at presentation. Î Recently two randomized clinical trials (RCTs) demonstrated that neoadjuvant chemotherapy (NACT) was noninferior to primary cytoreductive surgery (PCS) with respect to progression-free and overall survival and resulted in a lower incidence of treatment-related morbidity and mortality. • However, both trials have been criticized because the median overall survival, mean operative time, and rates of optimal cytoreduction were lower than expected. Î This Guideline provides guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Assessment Î All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy to determine whether they are candidates for primary cytoreductive surgery (PCS). (Strong recommendation; EB-B-I) Î A primary clinical evaluation should include a computed tomography (CT) scan of the abdomen and pelvis with oral and intravenous contrast and chest imaging (CT preferred) to evaluate the extent of disease and the feasibility of surgical resection. (Moderate recommendation; IC-B-I) • The use of other tools to refine this assessment may include laparoscopic evaluation or additional radiographic imaging (eg, [ 18 F]fluorodeoxyglucose positron-emission tomography [FDG-PET] scan or diffusion-weighted magnetic resonance imaging [MRI]). Î Women who have a high perioperative risk profile or a low likelihood of achieving cytoreduction to <1 cm (ideally to no visible disease) should

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