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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 126-127

Management of ovarian cancer


Department of Medical Oncology, Apex Hospital Pvt. Ltd., Jaipur, Rajasthan, India

Date of Submission31-Dec-2019
Date of Acceptance31-Dec-2019
Date of Web Publication24-Feb-2020

Correspondence Address:
Tarachand Gupta
Department of Medical Oncology, Apex Hospital Pvt. Ltd., Malviya Nagar, Jaipur - 302 017, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_128_19

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How to cite this article:
Gupta T. Management of ovarian cancer. Cancer Res Stat Treat 2020;3:126-7

How to cite this URL:
Gupta T. Management of ovarian cancer. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 7];3:126-7. Available from: http://www.crstonline.com/text.asp?2020/3/1/126/279086



Ovarian cancer is a common malignancy in females. Outcomes in epithelial ovarian cancers (EOC) have improved because of advancements in surgery and chemotherapy regimens, especially with the inclusion of targeted therapies.

In recent times, there has been an increase in the incidence of EOCs in young females, and it is heartening to see that we are moving toward fertility-saving surgery (FSS) in this cohort. However, we should be careful that FSS is safe for only Stage 1A with favorable histology – Grade 1 endometrioid, mucinous, low-grade serous – and also in Stage 1C (favorable histology) with unilateral ovarian involvement. FSS is not recommended for Stage IA/IC Grade 3 and any stage with clear cell histology. FSS is also not recommended for Stage II and III patients.[1]

For early-stage EOC patients with Stage 1A and 1B favorable histology – Grade 1 and Grade 2 endometrioid, mucinous, and low-grade serous adjuvant chemotherapy – has not shown any significant benefit. As per the International Collaborative Ovarian Neoplasm (ICON) 1 trial, adjuvant chemotherapy has the most significant impact in Stage 1 Grade 3, clear cell histology and high-grade serous EOC.[2]

In the survey published in this issue of the journal by Sapkota et al., 60% of the respondents preferred neoadjuvant chemotherapy (NACT) in all Stage III and IV EOC patients.[3],[4] As per the Cochrane database, NACT should be offered in Stage IIIC and IV ovarian cancers. We should also consider age, performance status, and histology before planning NACT or primary debulking surgery (PDS). In this group, NACT has shown benefit in removing complete macroscopic disease.[5] Chi DS et al. performed a retrospective analysis and concluded that all patients should undergo PDS and NACT should be offered if the patient is not fit for PDS or if R0 resection is not feasible.[6]

Majority of the participants (around 90%) were not in favor of using bevacizumab in the adjuvant setting. The ICON 7 trial suggested that bevacizumab leads to a progression-free survival and overall survival benefit in high-risk patients which include those with Stage IV and suboptimally debulked Stage III disease (residual disease >1 cm).[7]

To summarize, FSS should be performed with caution only in appropriate patients so that it does not affect survival. Now, because of the expanding training programs in medical oncology and gynecologic oncosurgery, we have a good number of experts in gynecologic oncology who can perform cytoreductive surgeries effectively and can manage patients with optimal chemotherapy regimens. Availability of generic forms of targeted therapies such as bevacizumab makes it convenient to offer maximum benefits in high-risk patients. Now, it is time to have uniform guidelines for the management of ovarian cancers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Satoh T, Hatae M, Watanabe Y, Yaegashi N, Ishiko O, Kodama S, et al. Outcomes of fertility-sparing surgery for stage I epithelial ovarian cancer: A proposal for patient selection. J Clin Oncol 2010;28:1727-32.  Back to cited text no. 1
    
2.
Trimbos JB, Parmar M, Vergote I, Guthrie D, Bolis G, Colombo N, et al. International collaborative ovarian neoplasm trial 1 and adjuvant chemotherapy in ovarian neoplasm trial: Two parallel randomized phase iii trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. J Natl Cancer Inst 2003;95:105-12.  Back to cited text no. 2
    
3.
Sapkota S, Abhyankar A, Dessai S. Ovarian cancer practice survey from the South Asian Association for Regional Cooperation (SAARC) nations. Cancer Res Stat Treat 2019;2:158-62.  Back to cited text no. 3
  [Full text]  
4.
Kaur S, Singh R. Patterns of care for ovarian cancer. Cancer Res Stat Treat 2019;2:217-20.  Back to cited text no. 4
  [Full text]  
5.
Morrison J, Haldar K, Kehoe S, Lawrie TA. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev. 2012;(8):CD005343.  Back to cited text no. 5
    
6.
Chi DS, Musa F, Dao F, Zivanovic O, Sonoda Y, Leitao MM, et al. An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). Gynecol Oncol 2012;124(1):10-4.   Back to cited text no. 6
    
7.
Oza AM, Cook AD, Pfisterer J, Embleton A, Ledermann JA, Pujade-Lauraine E, et al. Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): Overall survival results of a phase 3 randomised trial. Lancet Oncol 2015;16:928-36.  Back to cited text no. 7
    




 

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