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Surgeon Discusses Frontline Standard in Newly Diagnosed Ovarian Cancer

Caroline Seymour
Published: Wednesday, Jan 16, 2019

Neil Horowitz, MD

Neil Horowitz, MD

There are 2 potential treatment strategies for patients with newly diagnosed advanced ovarian cancer, explained Neil Horowitz, MD: primary cytoreductive surgery or neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Choosing between the 2, he added, can be a challenge.

State of the Science Summit™ on Ovarian Cancer, Horowitz, director of Clinical Research in Gynecologic Oncology, associate professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Dana-Farber Cancer Institute, discussed surgical options for patients with newly diagnosed ovarian cancer.

OncLive: What is the role of cytoreductive surgery for these patients?

Horowitz: The basis of my presentation [at the State of the Science SummitTM] was the role of cytoreductive surgery in the upfront management of ovarian cancer. We looked at historical data with regard to surgery. Additionally, work from Joseph Meigs, MD, showed that the amount of residual disease is a predictor of long-term outcomes for women with ovarian cancer. Following those data, we tried to define what optimal cytoreduction is and how that definition has changed over time—how it evolved from less than 2 cm to what we believe should be no gross residual disease.

We also compared the outcomes from primary cytoreductive surgery with neoadjuvant chemotherapy and interval cytoreduction. In addition, we discussed ways to predict which women may be best suited for upfront surgery versus neoadjuvant chemotherapy.

If a patient presents with advanced disease, how does that impact their surgical options?

Trying to decide which women should undergo primary cytoreductive surgery is a challenge. There is no standard predictive model, whether radiographic or in terms of CA125 values. There are certain disease locations that can be determined by imaging as “no-fly zones.”
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