tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2017-7-3-53-62tumors-439Research ArticleОБЗОРЫ И АНАЛИТИКАREVIEWS AND ANALYSISКРИТЕРИИ ОТБОРА БОЛЬНЫХ С ВЫСОКИМ ШАНСОМ ДОСТИЖЕНИЯ ОПТИМАЛЬНОЙ И ПОЛНОЙ ЦИТОРЕДУКЦИИCRITERIA FOR SELECTION OF PATIENTS WITH HIGH CHANCE OF COMPLETE OR OPTIMAL DEBULKING IN ADVANCED OVARIAN CANCERРумянцевА. А.RumyantsevA. A.

Алексей А. Румянцев - аспирант отделения клинической фармакологии и химиотерапии.

Москва

Alexey A. Rumyantsev - MD, postgraduate student of the Division of Clinical Pharmacology and Chemotherapy.

Moscow

alexeymma@gmail.comТюляндинаА. С.TjulandinaA. S.

Александра С. Тюляндина - кандидат медицинских наук, старший научный сотрудник отделения клинической фармакологии и химиотерапии.

Aleksanra S. Tjulandina - MD, PhD, Department of Clinical Pharmacology and Chemotherapy.

atjulandina@gmail.comПокатаевИ. А.PokataevI. A.

Илья А. Покатаев - кандидат медицинских наук, старший научный сотрудник отделения клинической фармакологии и химиотерапии.

Ilia A. Pokataev - MD, PhD, Department of Clinical Pharmacology and Chemotherapy.

pokia@mail.ruКупчанД. З.KupchanD. Z.

Дина З. Купчан - заведующая отделением организации и проведения клинических исследований.

Dina Z. Kupchan - Head of the Department of Organization and Conducting Clinical Studies.

ТюляндинС. А.TjulandinS. A.

Сергей А. Тюляндин - доктор медицинских наук, профессор, зав. отделением клинической фармакологии и химиотерапии.

Sergei A. Tjulandin - prof., MD, PhD, Department of Clinical Pharmacology and Chemotherapy.

stjulandin@gmail.comФГБУ РОНЦ им. Н.Н. БлохинаРоссияN. N. Blokhin Russian Cancer Research CenterRussian Federation201718012018745362Copyright © Румянцев А.А., Тюляндина А.С., Покатаев И.А., Купчан Д.З., Тюляндин С.А., 20182018Румянцев А.А., Тюляндина А.С., Покатаев И.А., Купчан Д.З., Тюляндин С.А.Rumyantsev A.A., Tjulandina A.S., Pokataev I.A., Kupchan D.Z., Tjulandin S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/439

Оптимальный подход к лечению пациенток с поздними стадиями рака яичников – краеугольный камень онкогинекологии. Современные рекомендации указывают на важность достижения полной или оптимальной циторедукции, а также на целесообразность назначения предоперационной химиотерапии пациенткам с низкой вероятностью их выполнения. Общепринятые критерии для отбора пациенток для первичной циторедукции и неоадъювантной химиотерапии отсутствуют. В данной статье систематизированы имеющиеся данные о прогнозировании результатов хирургического лечения пациенток на основе ряда клинических факторов, концентрации опухолевых маркеров и существующих прогностических моделей, основанных на результатах рентгенологических исследований (компьютерная томография, магнитно-резонансная томография, позитронно-эмиссионная томография). Подробно рассмотрена роль диагностической лапароскопии как метода оценки резектабельности опухолевого процесса у больных с поздними стадиями рака яичников. Рассмотрены критерии отбора пациенток для назначения предоперационной химиотерапии в различных клиниках и их опыт по использованию существующих методов диагностики.

The optimal approach to initial management of advanced ovarian cancer remains controversial. Current guidelines point out the high importance of surgical efforts to achieve complete or optimal cytoreduction and advisability of neoadjuvant chemotherapy as an option for patients with high risk of suboptimal debulking. However, there are no well-established criteria for patient selection for each approach. Here we provide a contemporary review of evidence for the utility of various methods for patient selection (eg, various clinical factors, serum levels of tumor markers, radiological models based on assessment of tumor dissemination pattern by computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT (PET/CT)). Capacity of these methods to predict surgical outcomes in patients with advanced ovarian cancer was evaluated. A detailed review of diagnostic laparoscopy as an emerging method for precise assessment of tumor resectability in these patients was made. We summarized the experience of dedicated cancer centers in patient selection for interval and primary debulking surgery as well as their experience in various diagnostic methods utilization in this setting.

рак яичниковпервичная циторедукцияинтервальная циторедукциянеоадъювантная химиотерапиякритерии отбораovarian cancerinterval debulkingprimary debulkingneoadjuvant chemotherapypatient selectionReferencesChang S. J., Hodeib M., Chang J., Bristow R. E. Survival impact of complete cytoreduction to no gross residual disease for advancedstage ovarian cancer: a meta-analysis. Gynecol Oncol., 2013 Sep, Vol. 130 (3), pp. 493–498.Chang S. J., Hodeib M., Chang J., Bristow R. E. Survival impact of complete cytoreduction to no gross residual disease for advancedstage ovarian cancer: a meta-analysis. Gynecol Oncol., 2013 Sep, Vol. 130 (3), pp. 493–498.du Bois A., Reuss A., Pujade-Lauraine E., Harter P., Ray-Coquard I., Pfisterer J. Role of Surgical Outcome as Prognostic Factor in Advanced Epithelial Ovarian Cancer: A Combined Exploratory Analysis of 3 Prospectively Randomized Phase 3 Multicenter Trials, Cancer, 2009, Vol. 115 (6), pp. 1234–44.du Bois A., Reuss A., Pujade-Lauraine E., Harter P., Ray-Coquard I., Pfisterer J. Role of Surgical Outcome as Prognostic Factor in Advanced Epithelial Ovarian Cancer: A Combined Exploratory Analysis of 3 Prospectively Randomized Phase 3 Multicenter Trials, Cancer, 2009, Vol. 115 (6), pp. 1234–44.Melamed A., Hinchcliff E.M., Clemmer J. T., Bregar A. J., Uppal S., Bostock I. et al. Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States. Gynecol. Oncol., 2016 Nov, Vol. 143 (2), pp. 236–240.Melamed A., Hinchcliff E.M., Clemmer J. T., Bregar A. J., Uppal S., Bostock I. et al. Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States. Gynecol. Oncol., 2016 Nov, Vol. 143 (2), pp. 236–240.Narod S., Sopik V. Neoadjuvant chemotherapy for advanced-stage ovarian cancer: Are the ASCO and SGO recommendations warranted? Gynecol. Oncol., 2017 Feb, Vol. 144 (2), pp. 238–240.Narod S., Sopik V. Neoadjuvant chemotherapy for advanced-stage ovarian cancer: Are the ASCO and SGO recommendations warranted? Gynecol. Oncol., 2017 Feb, Vol. 144 (2), pp. 238–240.Тюляндин С. А., Деньгина Н. В., Коломиец Л. А., Морхов К. Ю., Нечушкина В.М., Покатаев И. А. и др. Практические рекомендации по лекарственному лечению рака яичников/первичного рака брюшины/рака маточных труб. Злокачественные опухоли. 2016. № 4. Спецвыпуск 2. С. 123–134. [Tjulandin S. A., Dengina N. V., Kolomiets L. A., Morkhov K. Yu., Nechushkina V.M., Pokataev I. A. et al. Prakticheskie rekomendatsii po lekarstvennomu lecheniyu raka yaichnikov/pervichnogo raka bryushiny/raka matochnykh trub, Zlokachestvennye opukholi, 2016, No. 4, Special issue 2, pp. 123–134 (In Russ.)].Тюляндин С. А., Деньгина Н. В., Коломиец Л. А., Морхов К. Ю., Нечушкина В.М., Покатаев И. А. и др. Практические рекомендации по лекарственному лечению рака яичников/первичного рака брюшины/рака маточных труб. Злокачественные опухоли. 2016. № 4. Спецвыпуск 2. С. 123–134. [Tjulandin S. A., Dengina N. V., Kolomiets L. A., Morkhov K. Yu., Nechushkina V.M., Pokataev I. A. et al. Prakticheskie rekomendatsii po lekarstvennomu lecheniyu raka yaichnikov/pervichnogo raka bryushiny/raka matochnykh trub, Zlokachestvennye opukholi, 2016, No. 4, Special issue 2, pp. 123–134 (In Russ.)].Ассоциация Онкологов России. Клинические рекомендации по диагностике и лечению больных раком яичников, маточной трубы или первичным раком брюшины. Москва, 2014. [Assotsiatsiya Onkologov Rossii. Klinicheskie rekomendatsii po diagnostike i lecheniyu bolnykh rakom yaichnikov, matochnoy truby ili pervichnym rakom bryushiny, Moscow, 2014 (In Russ.)].Ассоциация Онкологов России. Клинические рекомендации по диагностике и лечению больных раком яичников, маточной трубы или первичным раком брюшины. Москва, 2014. [Assotsiatsiya Onkologov Rossii. Klinicheskie rekomendatsii po diagnostike i lecheniyu bolnykh rakom yaichnikov, matochnoy truby ili pervichnym rakom bryushiny, Moscow, 2014 (In Russ.)].Wright A.A., Bohlke K., Armstrong D.K., Bookman M.A., Cliby W.A., Coleman R. L. et al. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline, J. Clin. Oncol., 2016 Oct, Vol. 34 (28), pp. 3460–73.Wright A.A., Bohlke K., Armstrong D.K., Bookman M.A., Cliby W.A., Coleman R. L. et al. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline, J. Clin. Oncol., 2016 Oct, Vol. 34 (28), pp. 3460–73.NCCN Clinical Practice Guidelines in Oncology. Ovarian Cancer, Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Version 1, 2017.NCCN Clinical Practice Guidelines in Oncology. Ovarian Cancer, Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Version 1, 2017.Kehoe S., Hook J., Nankivell M., Jayson G.C., Kitchener H., Lopes T. et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial, Lancet, 2015, Vol. 386, pp. 249–257.Kehoe S., Hook J., Nankivell M., Jayson G.C., Kitchener H., Lopes T. et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial, Lancet, 2015, Vol. 386, pp. 249–257.Vergote I., Trope C.G., Amant F., Kristensen G.B., Ehlen T., Johnson N. et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer, N. Engl. J. Med., 2010; Vol. 363, pp. 943–953.Vergote I., Trope C.G., Amant F., Kristensen G.B., Ehlen T., Johnson N. et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer, N. Engl. J. Med., 2010; Vol. 363, pp. 943–953.Румянцев А.А., Тюляндина А.С., Покатаев И.А., Тюляндин С.А. Спорные вопросы оптимальной тактики хирургического лечения больных распространенным раком яичников. Злокачественные опухоли. 2017. Т. 7. № 3 С. 13-22. [Rumyantsev A.A., Tjulandina A.S., Pokataev I.A., Tjulandin S.A. Controversies in surgical treatment of advanced ovarian cancer, Malignant Tumours, Vol. 7, No. 3, pp. 13–22 (In Russ.)].Румянцев А.А., Тюляндина А.С., Покатаев И.А., Тюляндин С.А. Спорные вопросы оптимальной тактики хирургического лечения больных распространенным раком яичников. Злокачественные опухоли. 2017. Т. 7. № 3 С. 13-22. [Rumyantsev A.A., Tjulandina A.S., Pokataev I.A., Tjulandin S.A. Controversies in surgical treatment of advanced ovarian cancer, Malignant Tumours, Vol. 7, No. 3, pp. 13–22 (In Russ.)].Vergote I., Coens C., Nankivell M., Kristensen G., Parmer M., Ehlen T. et al. Meta-analysis of the randomized EORTC and CHORUS Neoadjuvant versus Primary Debulking trials in advanced Ovarian Cancer, Oral presentation at 16th Biennial Meeting of the International Gynecologic Cancer Society.Vergote I., Coens C., Nankivell M., Kristensen G., Parmer M., Ehlen T. et al. Meta-analysis of the randomized EORTC and CHORUS Neoadjuvant versus Primary Debulking trials in advanced Ovarian Cancer, Oral presentation at 16th Biennial Meeting of the International Gynecologic Cancer Society.Winter W. E. 3rd, Maxwell G. L., Tian C., Sundborg M. J., Rose G.S., Rose P.G. et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study, J. Clin. Oncol., 2008 Jan, Vol. 26 (1), pp. 83–89.Winter W. E. 3rd, Maxwell G. L., Tian C., Sundborg M. J., Rose G.S., Rose P.G. et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study, J. Clin. Oncol., 2008 Jan, Vol. 26 (1), pp. 83–89.Chi D.S., Venkatraman E.S., Masson V., Hoskins W. J. The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma, Gynecol. Oncol., 2000 May, Vol. 77 (2), pp. 227–231.Chi D.S., Venkatraman E.S., Masson V., Hoskins W. J. The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma, Gynecol. Oncol., 2000 May, Vol. 77 (2), pp. 227–231.Chi D.S., Zivanovic O., Palayekar M. J., Eisenhauer E. L., Abu-Rustum N.R., Sonoda Y. et al. A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma, Gynecol. Oncol., 2009 Jan, Vol. 112 (1), pp. 6–10.Chi D.S., Zivanovic O., Palayekar M. J., Eisenhauer E. L., Abu-Rustum N.R., Sonoda Y. et al. A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma, Gynecol. Oncol., 2009 Jan, Vol. 112 (1), pp. 6–10.Nick A.M., Coleman R. L., Ramirez P. T., Sood A.K. A framework for a personalized surgical approach to ovarian cancer, Nat.Rev. Clin. Oncol., 2015 Apr, Vol. 12 (4), pp. 239–245.Nick A.M., Coleman R. L., Ramirez P. T., Sood A.K. A framework for a personalized surgical approach to ovarian cancer, Nat.Rev. Clin. Oncol., 2015 Apr, Vol. 12 (4), pp. 239–245.Bristow R. E., Duska L.R., Lambrou N.C., Fishman E.K., O’Neill M. J. et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography, Cancer, 2000 Oct, Vol. 89 (7), pp. 1532–1540.Bristow R. E., Duska L.R., Lambrou N.C., Fishman E.K., O’Neill M. J. et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography, Cancer, 2000 Oct, Vol. 89 (7), pp. 1532–1540.Kim H. J., Choi C.H., Lee Y.Y., Kim T. J., Lee J.W. et al. Surgical outcome prediction in patients with advanced ovarian cancer using computed tomography scans and intraoperative findings, Taiwan J. Obstet. Gynecol., 2014 Sep, Vol. 53 (3), pp. 343–347.Kim H. J., Choi C.H., Lee Y.Y., Kim T. J., Lee J.W. et al. Surgical outcome prediction in patients with advanced ovarian cancer using computed tomography scans and intraoperative findings, Taiwan J. Obstet. Gynecol., 2014 Sep, Vol. 53 (3), pp. 343–347.Janco J.M., Glaser G., Kim B., McGree M. E., Weaver A. L. Development of a prediction model for residual disease in newly diagnosed advanced ovarian cancer, Gynecol. Oncol., 2015 Jul, Vol. 138 (1), pp. 70–77.Janco J.M., Glaser G., Kim B., McGree M. E., Weaver A. L. Development of a prediction model for residual disease in newly diagnosed advanced ovarian cancer, Gynecol. Oncol., 2015 Jul, Vol. 138 (1), pp. 70–77.Dowdy S.C., Mullany S.A., Brandt K.R., Huppert B. J., Cliby W.A. et al. The Utility of Computed Tomography Scans in Predicting Suboptimal Cytoreductive Surgery in Women with Advanced Ovarian Carcinoma, Cancer, 2004 Jul, Vol. 101 (2), pp. 346–352.Dowdy S.C., Mullany S.A., Brandt K.R., Huppert B. J., Cliby W.A. et al. The Utility of Computed Tomography Scans in Predicting Suboptimal Cytoreductive Surgery in Women with Advanced Ovarian Carcinoma, Cancer, 2004 Jul, Vol. 101 (2), pp. 346–352.Suidan R.S., Ramirez P. T., Sarasohn D.M., Teitcher J.B., Mironov S. et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer, Gynecol. Oncol., 2014 Sep, Vol. 134 (3), pp. 455–461.Suidan R.S., Ramirez P. T., Sarasohn D.M., Teitcher J.B., Mironov S. et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer, Gynecol. Oncol., 2014 Sep, Vol. 134 (3), pp. 455–461.Low R.N., Barone R.M., Lucero J. Comparison of MRI and CT for predicting the Peritoneal Cancer Index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures, Ann. Surg. Oncol., 2015 May, Vol. 22 (5), pp. 1708–1715.Low R.N., Barone R.M., Lucero J. Comparison of MRI and CT for predicting the Peritoneal Cancer Index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures, Ann. Surg. Oncol., 2015 May, Vol. 22 (5), pp. 1708–1715.Kasper S.M., Dueholm M., Marinovskij E., Blaakaer J. Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment, Eur. J. Obstet. Gynecol. Reprod. Biol., 2016 Oct, Vol. 210, pp. 83–89.Kasper S.M., Dueholm M., Marinovskij E., Blaakaer J. Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment, Eur. J. Obstet. Gynecol. Reprod. Biol., 2016 Oct, Vol. 210, pp. 83–89.Espada M., Garcia-Flores J.R., Jimenez M., Martinez-Vega V. Diffusion-weighted magnetic resonance imaging evaluation of intraabdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma, Eur. Radiol., 2013 Sep, Vol. 23 (9), pp. 2636–2642.Espada M., Garcia-Flores J.R., Jimenez M., Martinez-Vega V. Diffusion-weighted magnetic resonance imaging evaluation of intraabdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma, Eur. Radiol., 2013 Sep, Vol. 23 (9), pp. 2636–2642.Shim S.H., Lee S. J., Kim S.O., Kim S.N., Kim D.Y., Lee J. J. et al. Nomogram for predicting incomplete cytoreduction in advanced ovarian cancer patients, Gynecol. Oncol., 2015 Jan, Vol. 136 (1), pp. 30–36.Shim S.H., Lee S. J., Kim S.O., Kim S.N., Kim D.Y., Lee J. J. et al. Nomogram for predicting incomplete cytoreduction in advanced ovarian cancer patients, Gynecol. Oncol., 2015 Jan, Vol. 136 (1), pp. 30–36.Axtell A. E., Lee M.H., Bristow R. E., Dowdy S.C., Cliby W.A. et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer, J. Clin. Oncol., 2007 Feb, Vol. 25 (4), pp. 384–389.Axtell A. E., Lee M.H., Bristow R. E., Dowdy S.C., Cliby W.A. et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer, J. Clin. Oncol., 2007 Feb, Vol. 25 (4), pp. 384–389.Rutten M. J., van de Vrie R., Bruining A., Spijkerboer A.M., Mol B.W., Kenter G.G. et al. Predicting Surgical Outcome in Patients With International Federation of Gynecology and Obstetrics Stage III or IV Ovarian Cancer Using Computed Tomography, Int. J. Gynecol. Cancer, 2015 Mar, Vol. 25 (3), pp. 407–415.Rutten M. J., van de Vrie R., Bruining A., Spijkerboer A.M., Mol B.W., Kenter G.G. et al. Predicting Surgical Outcome in Patients With International Federation of Gynecology and Obstetrics Stage III or IV Ovarian Cancer Using Computed Tomography, Int. J. Gynecol. Cancer, 2015 Mar, Vol. 25 (3), pp. 407–415.Fagotti A., Ferrandina G., Fanfani F., Ercoli A., Lorusso D. A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study, Ann. Surg. Oncol., 2006 Aug, Vol. 13 (8), pp. 1156–1161.Fagotti A., Ferrandina G., Fanfani F., Ercoli A., Lorusso D. A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study, Ann. Surg. Oncol., 2006 Aug, Vol. 13 (8), pp. 1156–1161.Fagotti A., Ferrandina G., Fanfani F., Garganese G., Vizzielli G. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma, Am. J. Obstet. Gynecol., 2008, Vol. 199 (6), 642. e1–6.Fagotti A., Ferrandina G., Fanfani F., Garganese G., Vizzielli G. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma, Am. J. Obstet. Gynecol., 2008, Vol. 199 (6), 642. e1–6.Rutten M. J., van Meurs H.S., van de Vrie R., Gaarenstroom K.N., Naaktgeboren C.A., van Gorp T. et al. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial, J. Clin. Oncol., 2017 Feb, Vol. 35 (6), pp. 613–621.Rutten M. J., van Meurs H.S., van de Vrie R., Gaarenstroom K.N., Naaktgeboren C.A., van Gorp T. et al. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial, J. Clin. Oncol., 2017 Feb, Vol. 35 (6), pp. 613–621.Aletti G.D., Garbi A., Messori P., Achilarre M. T., Zanagnolo V., Rizzo S. et al. Multidisciplinary approach in the management of advanced ovarian cancer patients: A personalized approach. Results from a specialized ovarian cancer unit, Gynecol. Oncol., 2017 Mar, Vol. 144 (3), pp. 468–473.Aletti G.D., Garbi A., Messori P., Achilarre M. T., Zanagnolo V., Rizzo S. et al. Multidisciplinary approach in the management of advanced ovarian cancer patients: A personalized approach. Results from a specialized ovarian cancer unit, Gynecol. Oncol., 2017 Mar, Vol. 144 (3), pp. 468–473.Fagotti A., Vizzielli G., Fanfani F., Costantini B., Ferrandina G., Galotta V. et al. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: Impact on prognosis in a single institution experience, Gynecol. Oncol., 2013 Nov, Vol. 131 (2), pp. 341–346.Fagotti A., Vizzielli G., Fanfani F., Costantini B., Ferrandina G., Galotta V. et al. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: Impact on prognosis in a single institution experience, Gynecol. Oncol., 2013 Nov, Vol. 131 (2), pp. 341–346.Nick A.M., Coleman R. L., Ramirez K.M., Schmeler P. T., Soliman K.H., Burwaza J.K. et al. Personalized surgical therapy for advanced ovarian cancer. Presented at the American Society of Gynecologic Oncology Annual Meeting (2015).Nick A.M., Coleman R. L., Ramirez K.M., Schmeler P. T., Soliman K.H., Burwaza J.K. et al. Personalized surgical therapy for advanced ovarian cancer. Presented at the American Society of Gynecologic Oncology Annual Meeting (2015).Vergote I.B., van Nieuwenhuysen E., Vanderstichele A. How to Select Neoadjuvant Chemotherapy or Primary Debulking Surgery in Patients With Stage IIIC or IV Ovarian Carcinoma, J. Clin. Oncol., 2016 Sep 19, pii: JCO697458. [Epub ahead of print].Vergote I.B., van Nieuwenhuysen E., Vanderstichele A. How to Select Neoadjuvant Chemotherapy or Primary Debulking Surgery in Patients With Stage IIIC or IV Ovarian Carcinoma, J. Clin. Oncol., 2016 Sep 19, pii: JCO697458. [Epub ahead of print].Querleu D., Planchamp F., Chiva L., Fotopoulou C., Barton D., Cibula D. et al. European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery, Int. J. Gynecol. Cancer, 2016 Sep, Vol. 26 (7), pp. 1354–1363.Querleu D., Planchamp F., Chiva L., Fotopoulou C., Barton D., Cibula D. et al. European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery, Int. J. Gynecol. Cancer, 2016 Sep, Vol. 26 (7), pp. 1354–1363.

The authors declare that there are no conflicts of interest present.