ESMO Clinical Practice Guidelines for Nonepithelial Ovarian Cancer
Posted: Monday, July 2, 2018
New updates to guidelines for the diagnosis, treatment, and follow-up of nonepithelial ovarian cancer include recommendations of a bleomycin/etoposide/cisplatin regimen for many early-stage tumors and high-dose chemotherapy, surgery, or both for some advanced tumors. The new guidelines were published in the Annals of Oncology by the European Society for Medical Oncology (ESMO) Guidelines Committee, led by Isabelle Ray-Coquard, MD, PhD, of the Cancer Research Center of Lyon.
Regarding diagnosis, the guidelines recommend that diagnostic workups should include a pelvic ultrasound, abdominopelvic CT scan, chest x-ray, and in certain cases a PET scan. Under staging and risk assessment, recommended staging procedures include infracolic omentectomy and biopsy of the diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum, and peritoneal washings. To avoid tumor rupture during surgery, an open surgical approach is suggested; laparoscopy and robotics approaches may be indicated in selected cases. The guidelines report that “there is no consensus about the role of systematic lymphadenectomy,” and nodal debulking surgery is rarely required.
For early-stage germ cell tumors and early-stage sex cord–stromal tumors, 5-day bleomycin/etoposide/cisplatin is the most commonly used regimen. For recurrent germ cell tumors, high-dose chemotherapy has been effective at achieving long remissions, and fertility-sparing surgery should be considered for advanced-stage disease. Debulking surgery is the most effective treatment for recurrent or advanced-stage granulosa cell tumors, according to the guidelines. Hormone replacement therapy is not recommended for patients with sex cord–stromal tumors, but it is safe for patients with many germ cell tumors.
For evaluation of patients for treatment response, serum tumor markers may correlate with tumor response during chemotherapy. The guidelines address which imaging techniques are useful and what follow-up tests should be included.
For the full ESMO Clinical Practice Guidelines for nonepithelial ovarian cancer, see the link below.