Neoadjuvant chemotherapy for newly diagnosed advanced ovarian cancer
- Panagiotis A Konstantinopoulos, MD, PhD
Panagiotis A Konstantinopoulos, MD, PhD
- Assistant Professor of Medicine
- Harvard Medical School
- Gynecologic Medical Oncology Program
- Dana Farber Cancer Institute
- Robert E Bristow, MD, MBA
Robert E Bristow, MD, MBA
- University of California, Irvine - Medical Center
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Head of Women's Cancers, Lifespan Cancer Institute
- Director of Medical Oncology, Rhode Island Hospital
- Associate Professor of Medicine, Warren Alpert Medical School of Brown University
Epithelial cancers of ovarian, fallopian tube, and peritoneal origin exhibit similar clinical characteristics and behavior. As such, these are often combined together and define epithelial ovarian cancer (EOC) in clinical trials and clinical practice. This topic will consider all three histologies under the heading EOC.
EOC is the most common cause of death among women with gynecologic malignancies and the fifth leading cause of cancer death in women in the United States. Approximately 75 percent of women have stage III (disease that has spread throughout the peritoneal cavity or that involves lymph nodes) or stage IV (disease spread to more distant sites) disease at diagnosis. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)
For most patients, EOC is treated surgically and followed by adjuvant platinum and taxane-based chemotherapy. However, neoadjuvant chemotherapy (NACT) prior to definitive surgery is an alternative option in selected patients. This topic will review the rationale and administration of NACT for EOC. Other relevant topics in the treatment of EOC include:
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- PATIENT SELECTION
- PRETREATMENT EVALUATION
- Defining unresectable disease
- Role of diagnostic laparoscopy
- NACT VERSUS PRIMARY SURGERY
- EORTC 55971 trial
- Other trials
- CHOICE OF REGIMEN
- TREATMENT EVALUATION
- Response assessment
- DEFINITIVE SURGICAL TREATMENT
- Timing of interval surgical cytoreduction
- ADJUVANT TREATMENT
- Role of intraperitoneal therapy
- TREATMENT OF PATIENTS WHO PROGRESS ON NACT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS