Background: The surgical and medical management of recurrent ovarian cancer is complex and requires a personalized approach based on several factors, including the timing of recurrence, the patient’s performance status, previous treatment regimens, and the tumor’s histology and molecular characteristics.Objectives: Five randomized trials—GOG-0213, DESKTOP III, SOC 1, HORSE, and CHIPOR—have been conducted and shed light on our practice.Results: Both the DESKTOP III and the SOC 1 trials support the benefit of secondary surgery. The GOG-0213 trial, however, did not show an overall survival benefit, confirming that surgery should not be offered to all patients with platinum-sensitive recurrent ovarian cancer and highlighting the importance of strict patient selection using evidence-based selection criteria including the AGO or iMODEL scores. In patients with a negative score, there may be a place for cytoreductive surgery plus HIPEC in BRCA-negative cases following a course of chemotherapy, although current evidence shows no additional benefit for HIPEC when cytoreductive surgery is performed as an adjuvant procedure.Conclusions: Secondary surgery is recommended for platinum-sensitive patients when respecting AGO or iModel criteria. In addition, surgery plus HIPEC can be considered in BRCA-negative patients with an initial negative AGO or iMODEL score who show sufficient response following a course of neoadjuvant chemotherapy to then be considered operable.
背景：复发性卵巢癌的手术与药物治疗管理复杂，需根据多种因素采取个体化策略，包括复发时间、患者体能状态、既往治疗方案以及肿瘤组织学与分子特征。 目的：目前已完成的五项随机试验——GOG-0213、DESKTOP III、SOC 1、HORSE和CHIPOR——为临床实践提供了重要依据。 结果：DESKTOP III和SOC 1试验均支持二次手术的获益。然而，GOG-0213试验未显示总体生存获益，这证实了并非所有铂敏感复发性卵巢癌患者均适合手术，并突显了基于AGO或iMODEL评分等循证标准进行严格患者筛选的重要性。对于评分阴性且BRCA阴性的患者，在一段化疗后可能考虑减瘤手术联合腹腔热灌注化疗（HIPEC），尽管现有证据表明在辅助治疗阶段进行减瘤手术时，HIPEC并未带来额外生存获益。 结论：对于铂敏感患者，若符合AGO或iMODEL标准，推荐进行二次手术。此外，对于初始AGO或iMODEL评分阴性、BRCA阴性且在新辅助化疗后显示充分缓解从而具备手术条件的患者，可考虑手术联合HIPEC治疗。
肿瘤(癌症)患者之家