Women With Advanced Ovarian Cancer Should See Gynecologic Oncologist Prior to Therapy
By David Douglas
NEW YORK (Reuters Health) - All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be seen by a gynecologic oncologist before starting treatment.
That's according to new practice guidelines from The Society of Gynecologic Oncology (SGO) and the American Society of Clinical Oncology (ASCO), published online August 8 in the Journal of Clinical Oncology.
"This is an important collaboration between the SGO and ASCO who recognized the need to provide evidence-based guidelines for clinicians when using neoadjuvant chemotherapy for women with newly diagnosed advanced ovarian cancer," Dr. Mitchell Edelson, co-chair of the guideline panel, told Reuters Health by email.
"The recommendations," he added, "focus on the appropriate evaluation and criteria to be utilized to determine whether neoadjuvant chemotherapy or primary cytoreductive surgery should be offered to women with newly diagnosed Stage IIIC or IV ovarian cancer."
Dr. Edelson of Hanjani Institute for Gynecologic Oncology in Abington, Pennsylvania, and colleagues conducted a systematic literature review and based their recommendations on outcome from four phase III clinical trials.
The authors advise including CT of the abdomen and pelvis as well as chest imaging as part of the primary evaluation of patients. Women with a high perioperative risk profile or a low likelihood of achieving adequate cytoreduction should receive neoadjuvant chemotherapy, they say.
However, confirmation of an invasive ovarian, fallopian tube or peritoneal cancer is required in all patients before delivery of neoadjuvant chemotherapy.
Either neoadjuvant chemotherapy or primary cytoreductive surgery is appropriate in women who are fit for primary cytoreductive surgery and have potentially resectable disease. But surgery is preferable if there is a high likelihood of achieving cytoreduction to visible disease with acceptable morbidity, according to the guidelines.
In selected women, the authors say, overall and progression-free survival with chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy. The approach is also associated with less perioperative morbidity and mortality.
Dr. Edelson said the panel "also discussed areas for future research with clinical trials." Among these are development and validation of a preoperative risk prediction model to identify patients who are at high risk of morbidity with primary cytoreductive surgery.
J Clin Oncol 2016.
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