Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients

Abstract

Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration: (1) the disease factor, related to the extension and localization of the disease as well as tumor biology; (2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and (3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.

Keywords: Advanced stage; Neoadjuvant chemotherapy; Ovarian cancer; Patients’ selection; Primary debulking surgery.

Figure 1

Stepwise management of women with suspected advanced-stage ovarian cancer. CT: Computer tomography.

Figure 2

Multidisciplinary surgical team for treating women with advanced-stage ovarian cancer. ICU: Intensive care unit.