Multidisciplinary approach in the management of advanced ovarian cancer patients: A personalized approach. Results from a specialized ovarian cancer unit

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Abstract

Objective The aim of the present study was to evaluate the impact of a multidisciplinary approach in patients' selection with advanced ovarian cancer (AOC) for different therapeutic strategies. Methods Patients referred at our institution between 2009 and 2012 for AOC were included. Primary multidisciplinary evaluation was performed in all patients. Different strategies included: 1. patients referred to primary neoadjuvant chemotherapy (NACT) and interval surgery (IDS) (group A); 2. patients considered for surgical exploration. After surgical exploration, patients were either considered for primary debulking (PDS; group B), or NACT (group C). Results A total of 363 patients were included. Of 38 patients (10.5%) in group A, 24 (63%) had sovradiaphragmatic/multiple liver metastases; 14 (37%) were excluded for PDS for anestehesiologic/medical reasons. Of 325 (89.5%) considered for surgical exploration, 295 (91%; group B) had primary surgery with debulking intent (N: 277) and were cytoreduced to no macroscopic disease (R0: N:200; 68%) o minimal RD < 5 mm (R1: N:77; 26%) or palliative intent (N:18; 6%); 30 (9%; group C) were referred for NACT. Of those, 27 (90%) underwent IDS, 3 had progressive disease. Overall survival (OS) and progression free survival (PFS) was different between the groups: OS: Group A: 34 months; Group B: 59 months; Group C: 29 months; p < 0.001. PFS: Group A: 10 months; Group B; 21 months; Group C: 12 months; p < 0.001. Conclusions A multidisciplinary approach to patients referred to a tertiary center with AOC allows optimization of the treatment strategy, based on patients' characteristics (age, performance/nutritional status, comorbidities, functional status) and tumor diffusion (evaluated pre- and intraoperatively).

Original languageEnglish
Pages (from-to)468-473
Number of pages6
JournalGynecologic Oncology
Volume144
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

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Ovarian Neoplasms
Drug Therapy
Disease-Free Survival
Survival
Nutritional Status
Patient Selection
Comorbidity
Neoplasm Metastasis
Liver
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{bcd4b14a93034e91b4d2bf25946b9a94,
title = "Multidisciplinary approach in the management of advanced ovarian cancer patients: A personalized approach. Results from a specialized ovarian cancer unit",
abstract = "Objective The aim of the present study was to evaluate the impact of a multidisciplinary approach in patients' selection with advanced ovarian cancer (AOC) for different therapeutic strategies. Methods Patients referred at our institution between 2009 and 2012 for AOC were included. Primary multidisciplinary evaluation was performed in all patients. Different strategies included: 1. patients referred to primary neoadjuvant chemotherapy (NACT) and interval surgery (IDS) (group A); 2. patients considered for surgical exploration. After surgical exploration, patients were either considered for primary debulking (PDS; group B), or NACT (group C). Results A total of 363 patients were included. Of 38 patients (10.5{\%}) in group A, 24 (63{\%}) had sovradiaphragmatic/multiple liver metastases; 14 (37{\%}) were excluded for PDS for anestehesiologic/medical reasons. Of 325 (89.5{\%}) considered for surgical exploration, 295 (91{\%}; group B) had primary surgery with debulking intent (N: 277) and were cytoreduced to no macroscopic disease (R0: N:200; 68{\%}) o minimal RD < 5 mm (R1: N:77; 26{\%}) or palliative intent (N:18; 6{\%}); 30 (9{\%}; group C) were referred for NACT. Of those, 27 (90{\%}) underwent IDS, 3 had progressive disease. Overall survival (OS) and progression free survival (PFS) was different between the groups: OS: Group A: 34 months; Group B: 59 months; Group C: 29 months; p < 0.001. PFS: Group A: 10 months; Group B; 21 months; Group C: 12 months; p < 0.001. Conclusions A multidisciplinary approach to patients referred to a tertiary center with AOC allows optimization of the treatment strategy, based on patients' characteristics (age, performance/nutritional status, comorbidities, functional status) and tumor diffusion (evaluated pre- and intraoperatively).",
author = "Aletti, {Giovanni Damiano} and Annalisa Garbi and Pietro Messori and Achilarre, {Maria Teresa} and Vanna Zanagnolo and Stefania Rizzo and Sarah Alessi and Luca Bocciolone and Fabio Landoni and Roberto Biffi and Silvestro Carinelli and Nicoletta Colombo and Angelo Maggioni",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.ygyno.2017.01.017",
language = "English",
volume = "144",
pages = "468--473",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
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TY - JOUR

T1 - Multidisciplinary approach in the management of advanced ovarian cancer patients

T2 - A personalized approach. Results from a specialized ovarian cancer unit

AU - Aletti, Giovanni Damiano

AU - Garbi, Annalisa

AU - Messori, Pietro

AU - Achilarre, Maria Teresa

AU - Zanagnolo, Vanna

AU - Rizzo, Stefania

AU - Alessi, Sarah

AU - Bocciolone, Luca

AU - Landoni, Fabio

AU - Biffi, Roberto

AU - Carinelli, Silvestro

AU - Colombo, Nicoletta

AU - Maggioni, Angelo

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objective The aim of the present study was to evaluate the impact of a multidisciplinary approach in patients' selection with advanced ovarian cancer (AOC) for different therapeutic strategies. Methods Patients referred at our institution between 2009 and 2012 for AOC were included. Primary multidisciplinary evaluation was performed in all patients. Different strategies included: 1. patients referred to primary neoadjuvant chemotherapy (NACT) and interval surgery (IDS) (group A); 2. patients considered for surgical exploration. After surgical exploration, patients were either considered for primary debulking (PDS; group B), or NACT (group C). Results A total of 363 patients were included. Of 38 patients (10.5%) in group A, 24 (63%) had sovradiaphragmatic/multiple liver metastases; 14 (37%) were excluded for PDS for anestehesiologic/medical reasons. Of 325 (89.5%) considered for surgical exploration, 295 (91%; group B) had primary surgery with debulking intent (N: 277) and were cytoreduced to no macroscopic disease (R0: N:200; 68%) o minimal RD < 5 mm (R1: N:77; 26%) or palliative intent (N:18; 6%); 30 (9%; group C) were referred for NACT. Of those, 27 (90%) underwent IDS, 3 had progressive disease. Overall survival (OS) and progression free survival (PFS) was different between the groups: OS: Group A: 34 months; Group B: 59 months; Group C: 29 months; p < 0.001. PFS: Group A: 10 months; Group B; 21 months; Group C: 12 months; p < 0.001. Conclusions A multidisciplinary approach to patients referred to a tertiary center with AOC allows optimization of the treatment strategy, based on patients' characteristics (age, performance/nutritional status, comorbidities, functional status) and tumor diffusion (evaluated pre- and intraoperatively).

AB - Objective The aim of the present study was to evaluate the impact of a multidisciplinary approach in patients' selection with advanced ovarian cancer (AOC) for different therapeutic strategies. Methods Patients referred at our institution between 2009 and 2012 for AOC were included. Primary multidisciplinary evaluation was performed in all patients. Different strategies included: 1. patients referred to primary neoadjuvant chemotherapy (NACT) and interval surgery (IDS) (group A); 2. patients considered for surgical exploration. After surgical exploration, patients were either considered for primary debulking (PDS; group B), or NACT (group C). Results A total of 363 patients were included. Of 38 patients (10.5%) in group A, 24 (63%) had sovradiaphragmatic/multiple liver metastases; 14 (37%) were excluded for PDS for anestehesiologic/medical reasons. Of 325 (89.5%) considered for surgical exploration, 295 (91%; group B) had primary surgery with debulking intent (N: 277) and were cytoreduced to no macroscopic disease (R0: N:200; 68%) o minimal RD < 5 mm (R1: N:77; 26%) or palliative intent (N:18; 6%); 30 (9%; group C) were referred for NACT. Of those, 27 (90%) underwent IDS, 3 had progressive disease. Overall survival (OS) and progression free survival (PFS) was different between the groups: OS: Group A: 34 months; Group B: 59 months; Group C: 29 months; p < 0.001. PFS: Group A: 10 months; Group B; 21 months; Group C: 12 months; p < 0.001. Conclusions A multidisciplinary approach to patients referred to a tertiary center with AOC allows optimization of the treatment strategy, based on patients' characteristics (age, performance/nutritional status, comorbidities, functional status) and tumor diffusion (evaluated pre- and intraoperatively).

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