open access: PLOS ONE: Clinical Course of Patients Treated for Advanced Ovarian Carcinoma without Surgical Intervention

PLOS ONE: Clinical Course of Patients Treated for Advanced Ovarian Carcinoma without Surgical Intervention

Objective

To describe the clinical course and outcome of patients with non-surgically-treated advanced ovarian cancer attending a single institute.

Introduction

Surgery is central in the treatment of ovarian carcinoma. Surgical staging procedures are employed for apparent stage 1 disease, and extensive cytoreductive surgery is believed to be vital for long-term survival in patients with advanced epithelial ovarian cancer [1], [2]. Patients left with minimal residual disease fare better than patients who remain with bulkier lesions [3]–[5]. Whether the maximal surgical effort should be made upfront, at diagnosis, or after neo-adjuvant chemotherapy is still unclear [6]. Over the last two decades, several studies have addressed the use of chemotherapy prior to surgery in women with advanced epithelial ovarian cancer [7]–[9], and recently, a large randomized trial suggested that neoadjuvant chemotherapy is not detrimental to survival relative to upfront surgery [10].
The finding that some patients with advanced peritoneal disease remain with only minimal or even no residual disease by interval cytoreduction raises the question of the added value of surgery to the clinical course in these cases. This issue is important, because not all patients with advanced ovarian cancer are eligible for surgery owing to background medical conditions that rule out laparotomy and extensive resection or poor performance status, and others refuse surgery for personal reasons. Our search of the literature yielded no contemporary studies of patients with ovarian carcinoma treated without surgery at all.......