Surgery for recurrent ovarian cancer: expert point of view

Abstract

: The initial treatment of ovarian cancer consists of a combined approach of surgery and platinum-based chemotherapy. Complete resection of the tumor should be aimed for, if not manageable, neoadjuvant chemotherapy (NAC) followed by interval debulking is recommended. Until recently, treatment strategies for the recurrent setting were mainly focusing on systemic therapies. Currently published trials including DESKTOP III, GOG 213 and SOC 1 did randomize patients with first platinum-sensitive recurrence to either surgery, aiming for complete cytoreduction, followed by platinum-based chemotherapy or chemotherapy alone. All three trials did report a benefit for the surgery arm in terms of progression free survival (PFS), while two of the studies did also show an improved overall survival (OS), this was not the case in the GOG 213 trial, with better result in terms of OS for the chemotherapy + bevacizumab arm. All the above-mentioned studies confirmed that only interventions leading to complete resection provided a benefit, highlighting the need to carefully select the patients who will be offered surgery. A score can be a useful tool but should not be the only basis of the final decision. Noteworthy, these results were obtained in trained centers. Apart from that, the homologous recombination deficiency (HRD) and BRCA status of the patient needs to be taken into consideration. In case of an indication for anti-angiogenic treatment in the event of a relapse and if not given initially, surgery is debatable. The role of maintenance therapy with PARP inhibitor alone or in combination is also an alternative.