This is part 1 of a 2-part series on the new ESMO-ESGO recommendations for ovarian cancer.
- European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO) issue recommendations for the management of early-stage and borderline ovarian cancer.
- Surgical management:
- Perform laparotomy for early-stage cancer.
- Minimally invasive surgery can be performed for restaging.
- Peritoneal restaging surgery is mandatory.
- Peritoneal restaging should be considered in cases of incidentally detected, apparently isolated serous tubal intraepithelial carcinoma (STIC) lesions.
- Surgical staging with systematic lymph node dissection of the pelvic and the paraaortic regions is the standard.
- Fertility-sparing surgery:
- Can be offered to all stage IA and IC1 low-grade carcinomas, but not for stage >I.
- Adjuvant chemotherapy:
- Recommended for patients with stage I-IIA ovarian cancer.
- Not recommended for incidentally detected isolated STIC lesions.
- Carboplatin alone or in combination with paclitaxel is acceptable treatment regimen; ≥3 cycles are recommended.
- Borderline ovarian tumors (BOTs):
- Offer fertility-sparing surgery to young patients.
- Unilateral salpingo-oophorectomy is recommended for mucinous BOTs.
- Cystectomy may be offered for serous BOTs (sBOTs) to preserve fertility.
- Perform peritoneal staging surgery for sBOTs.
- Consider restaging for sBOTs with micropapillary pattern or incomplete visual exploration of the peritoneal cavity.
- Remove peritoneal implants for staging and therapeutic purposes in sBOTs.
- Consider fertility-sparing surgery for selected patients with stage II-III sBOTs.