Michelle M. Boisen, MD, assistant professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center Hillman Cancer Center, discusses the scoring system for optimal debulking in ovarian cancer.

A few trials were published that looked at developing a scoring system to predict how likely a patient would be successfully optimally debulked, says Boisen. The goal of all these surgies is to get patients to <1 cm of residual disease with, ideally, no visible residual disease. A scoring system was developed based on the location of patients’ disease and determined that if a patient has a score of <8 versus >8, then their chance of being optimally debulked is “X.”

At UPMC, something similar is done where a scope is put in and it's used to assess the disease on the diaphragm, the liver surface, and the stomach. Then patients are scored and triaged based on that information, concludes Boisen.

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Michelle M. Boisen, MD, discusses the scoring system for optimal debulking in ovarian cancer.

Dr. Boisen on Scoring System for Optimal Debulking in Ovarian Cancer

Michelle M. Boisen, MD, assistant professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center Hillman Cancer Center, discusses selection criteria for upfront surgery versus neoadjuvant chemotherapy in advanced ovarian cancer.

Patients who are unlikely to tolerate a radical surgery with minimal morbidity or patients who may not be fit to receive adjuvant chemotherapy should not be considered for surgery, explains Boisen. Instead, these patients should be given neoadjuvant chemotherapy.

Patients with stage IVb disease whose disease is not resectable in the upfront setting should also receive neoadjuvant chemotherapy, says Boisen.

If the resectability of the patient is unclear, diagnostic laparoscopy can be used to determine whether neoadjuvant chemotherapy or upfront surgery is the optimal treatment option, concludes Boisen.

Michelle M. Boisen, MD, discusses criteria for selecting patients with ovarian cancer for upfront surgery versus neoadjuvant chemotherapy.

Dr. Boisen on Selecting Patients for Surgery Versus Neoadjuvant Chemotherapy in Ovarian Cancer

Michelle M. Boisen, MD, assistant professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, discusses the selection of neoadjuvant chemotherapy versus upfront surgery for women with newly diagnosed ovarian cancer.

In the past decade, data from randomized trials comparing upfront surgical resection with neoadjuvant chemotherapy have shown a lower mortality rate in patients who undergo neoadjuvant chemotherapy prior to surgery, says Boisen.

However, additional investigation is needed to determine the relative impact of neoadjuvant chemotherapy versus surgery on a patient’s long-term prognosis.

Prospective studies suggest that outcomes with neoadjuvant chemotherapy and upfront surgical resection are similar; however, the extent of the surgery performed in clinical trials has not been standardized, says Boisen.

In practice, surgery should be pursued for fit patients with newly diagnosed disease who are able to undergo an optimal debulking surgery, concludes Boisen.

Michelle M. Boisen, MD, discusses the selection of neoadjuvant chemotherapy versus upfront surgery for women with newly diagnosed ovarian cancer.

Michelle M. Boisen, MD

Articles

Dr. Boisen on Scoring System for Optimal Debulking in Ovarian Cancer

Dr. Boisen on Selecting Patients for Surgery Versus Neoadjuvant Chemotherapy in Ovarian Cancer

Dr. Boisen on Neoadjuvant Chemotherapy Versus Upfront Surgery in Ovarian Cancer