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A framework for a personalized surgical approach to ovarian cancer

Nature Reviews Clinical Oncology volume 12, pages 239–245 (2015)Cite this article

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Abstract

The standard approach for the treatment of advanced-stage ovarian cancer is upfront cytoreductive surgery followed by a combination of platinum-based and taxane-based chemotherapy. The extent of residual disease following upfront cytoreductive surgery correlates with objective response to adjuvant chemotherapy, rate of pathological complete response at second-look assessment operations, and progression-free survival and overall survival. Contemporary data and meta-analyses indicate a correlation between volume of residual disease and patient outcome, with those patients undergoing complete gross resection having the best outcomes. Thus, attention has focused on surgical efforts to remove as much disease as possible with the metric of 'optimal' cytoreduction being R0 disease. Because patients with R0 resection seem to have the best overall outcomes, preoperative or intraoperative assessment to avoid unnecessary primary debulking surgery has become common. The use of serum CA-125 levels, physical examination and CT imaging have lacked accuracy in determining if disease can be optimally debulked. Therefore, an algorithm that identifies patients in whom complete gross resection at primary surgery is likely to be achieved would be expected to improve patient survival. We discuss contemporary definitions of 'optimal' residual disease, and opportunities to personalize surgical therapy and improve the quality of surgical care.

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Figure 1: Plaque-like disease involving the diaphragm.
Figure 2: Key features of the MD Anderson Cancer Center, TX, USA, quality improvement programme.
Figure 3: Novel clinical trial design for patients treated on the Anderson Algorithm.

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Acknowledgements

The authors thank all faculty members of the Department of Gynecologic Oncology & Reproductive Medicine, MD Anderson Cancer Center, TX, USA, for highly productive discussions, and also the Women's Cancer Moon Shot Program for their support. The work of the authors was supported in part by the NIH (grants P50CA083639, U54CA151668, UH2TR000943, CA016672), Cancer Prevention Research Institute of Texas (CPRIT; grants RP110595, RP120214), Ovarian Cancer Research Fund Program Project Development Grant, Department of Defence grants (OC120547 and OC093416), the Judy Rees Ovarian Cancer Fund, the Ann Rife Cox Chair in Gynecology, the Betty Ann Asche Murray Distinguished Professorship, the Blanton-Davis Ovarian Cancer Research Program, and the generous philanthropic contributions to The University of Texas MD Anderson Moon Shots Program (DeCesaris/Prout Cancer Foundation, The Ellwood Foundation, Lyda Hill, Marathon Oil Corporation, and PGA Tour, Inc.).

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Authors and Affiliations

  1. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Drive, P.O. Box 301349, Houston, 77230-1439, TX, USA

    Alpa M. Nick, Robert L. Coleman, Pedro T. Ramirez & Anil K. Sood

  2. Department of Cancer Biology, Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Drive, P.O. Box 301349, Houston, 77230-1439, TX, USA

    Anil K. Sood

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A.M.N. researched the data for the article and wrote the manuscript; A.M.N., R.L.C., and A.K.S. contributed substantially to discussion of content; and all authors reviewed/edited the manuscript before submission.

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Correspondence to Alpa M. Nick.

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Nick, A., Coleman, R., Ramirez, P. et al. A framework for a personalized surgical approach to ovarian cancer. Nat Rev Clin Oncol 12, 239–245 (2015). https://doi.org/10.1038/nrclinonc.2015.26

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