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World J Methodol. Dec 26, 2015; 5(4): 196-202
Published online Dec 26, 2015. doi: 10.5662/wjm.v5.i4.196
Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients
Lucas Minig, Cristina Zorrero, Pablo Padilla Iserte, Andres Poveda
Lucas Minig, Cristina Zorrero, Pablo Padilla Iserte, Gynecology Department, Clinical Area of Gynecologic Oncology, Valencian Institue of Oncology, 46009 Valencia, Spain
Andres Poveda, Medical Oncology Department, Clinical Area of Gynecologic Oncology, Valencian Institue of Oncology, 46009 Valencia, Spain
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lucas Minig, MD, PhD, MBA, Gynecology Department, Clinical Area of Gynecologic Oncology, Valencian Institue of Oncology, C/del Profesor Beltran Baguena 8, 46009 Valencia, Spain. miniglucas@gmail.com
Telephone: +34-96-1114024 Fax: +34-96-1114024
Received: July 28, 2015
Peer-review started: July 31, 2015
First decision: August 14, 2015
Revised: August 27, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 26, 2015
Processing time: 138 Days and 15.6 Hours
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: Ovarian cancer; Advanced stage; Primary debulking surgery; Neoadjuvant chemotherapy; Patients’ selection

Core tip: Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Surgeries performed by gynecologic oncologists with formal training in cytoreductive techniques at referral centers are crucial factors in obtaining better oncologic outcomes. However, other factors such as clinical status of the patients, the hospital’s infrastructure and equipment, as well as the tumor biology of each individual patient should also be taken into account before deciding on an initial strategy of treatment in women with advanced-stage ovarian cancer.