Format

Send to

Choose Destination
Nat Rev Clin Oncol. 2015 Apr;12(4):239-45. doi: 10.1038/nrclinonc.2015.26. Epub 2015 Feb 24.

A framework for a personalized surgical approach to ovarian cancer.

Author information

1
Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Drive, P.O. Box 301349, Houston, TX 77230-1439, USA.
2
1] Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Drive, P.O. Box 301349, Houston, TX 77230-1439, USA. [2] Department of Cancer Biology, Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Drive, P.O. Box 301349, Houston, TX 77230-1439, USA.

Abstract

The standard approach for the treatment of advanced-stage ovarian cancer is upfront cytoreductive surgery followed by a combination of platinum-based and taxane-based chemotherapy. The extent of residual disease following upfront cytoreductive surgery correlates with objective response to adjuvant chemotherapy, rate of pathological complete response at second-look assessment operations, and progression-free survival and overall survival. Contemporary data and meta-analyses indicate a correlation between volume of residual disease and patient outcome, with those patients undergoing complete gross resection having the best outcomes. Thus, attention has focused on surgical efforts to remove as much disease as possible with the metric of 'optimal' cytoreduction being R0 disease. Because patients with R0 resection seem to have the best overall outcomes, preoperative or intraoperative assessment to avoid unnecessary primary debulking surgery has become common. The use of serum CA-125 levels, physical examination and CT imaging have lacked accuracy in determining if disease can be optimally debulked. Therefore, an algorithm that identifies patients in whom complete gross resection at primary surgery is likely to be achieved would be expected to improve patient survival. We discuss contemporary definitions of 'optimal' residual disease, and opportunities to personalize surgical therapy and improve the quality of surgical care.

PMID:
25707631
PMCID:
PMC4528308
DOI:
10.1038/nrclinonc.2015.26
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Nature Publishing Group Icon for PubMed Central
Loading ...
Support Center