Treatment of Advanced Ovarian Cancer

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Treatment of Advanced Ovarian Cancer
Ayhan A, MD. H a c e t t e p e U n i v e r s i
t y F a c u l t y o f M e d i c i n e D E P
A R T M E N T O F O B S T E T R I C S A N
D G Y N E C O L O G Y
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Epithelial Ovarian Cancer

• 4 of all female cancers
• 25 of all gynecologic cancers
• life time risk 1/70
• ¾ advanced stage
• most lethal

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Classification of EOC

• serous (75 80)
• mucinous (10)
• endometrioid (10)
• Brenner, clear cell, undif. (1)
• 15 Borderline

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Ovarian Malignancies in Hacettepe
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Stage distribution of EOC(Hacettepe)
STAGE
235
I
105
II
385
III
186
IV
908
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Histological Subtypes of EOC(Hacettepe)
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Therapy in EOC
age, performance
extent of tumor
fertility desire
histologic subtypes
grade
others
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Treatment
M O D A L I T I E S
Surgery
Adjuvant
Supportive
Stoma ...
Chemotherapy
Staging
Complementary
Platin based
Nutrition
Fertility saving
Psychosomatic
Radiotherapy
Cytoreductive
Whole abd.
Second look
32P
Bowel surgery
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Aim of Surgery
Prognosticinformation
Accurate Diagnosis
Extent of tumor
Decision for finalTreatment
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Goal of Cytoreduction
Removal of ALLPrimary Whole metastatictumors
Or at least less than 1cm
Or at least less than 1cm
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Cytoreduction
Cytoreductive Surgery
PrimaryCytoreduction
Secondary Cytoreduction
Interval Debulking
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What is the Definition of OPTIMAL STATUS and
why?
Median Surv
Diameter
6 months
15mm
18 months
5-10mm
40 months
lt5mm
At least 1gr or 1cm Diameter Griffiths, Hoskins
(GOG), Hacker, Berek...
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For effective Cytoreduction
Experience
Retroperitonealtumor
Inherent factors of tumor itself
Upper abdominal tumor
Fixed Pelvic mass
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Cytoreductive Surgery
Resection of all metastatic tumor and related
organs
TAHBSO
Bowel resection Liver resection Splenectomy Lympha
denectomy Diaphragmatic peritoneal resection
Total Omentectomy
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Additional Surgical Procedures During
Cytoreduction (Hacettepe)
N
PROCEDURE
57
Sigmoid resection
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Ileal/Ileachecal resection
10
Cystectomy
48
Splenectomy
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Bowel Resection

• For Optimal cytoreduction (87)
• To Prevent or treat obstruction

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DebulkingHacettepe Experience(N673)
77.4 OPTIMAL
SUBOPTIMAL22.6
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What is the Role of Cytoreduction in Stage IV
Liver (84 pts) Optimal Debulking
Parenchymal debulking
No parenchymal debulking
50months
25months
Bristow 1999
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Lymphadenectomy in Advanced Ovarian Cancer
Lymphadenectomy
2yr Survival
Performed
59
Not performed
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Scarabelli et al, di Re F et al.
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OUTCOME OF OPTIMAL CYTOREDUCTION
Hoskins et al., Boardman et al.
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CHEMOTHERAPY
PLATIN BASED58
NON-PLATIN BASED42
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EPITHELIAL OVARIAN CANCER5-yr OS ()
88
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StageI-II
StageIII-IV
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5-yr OS () with respect to second look
laparotomy(n254)
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Interval Cytoreduction
Suboptimal Surgery
3 cycle chemotherapy
Cytoreduction
3 cycle chemotherapy
Second look Surgery
EORTC and Ongoing GOG
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Cytoreduction after Neoadjuvant Chemotherapy
Initially inappropriate for Surgery
Tissue diagnosis
3 cycle chemotherapy
CYTOREDUCTION
3 cycle chemotherapy
Park et al, Schwartz et al, ...
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CONCLUSION Advanced Stage Ovarian Cancer
Optimal Cytoreduction
PaclitaxelPlatin
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CONCLUSION Advanced Stage Ovarian Cancer

Suboptimal surgery Interval debulking
Poor performance or unresectable tumor
Neo-adjuvant chemotherapy
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Thank you...