Ovarian (includes fallopian tube and primary peritoneal) Flashcards
screening
VIDEO**
PLCO trial shows evidence of HARM for low risk pts
no mortality difference
role of surgery
primary tx for ALL stages, by trained gyn-onc surgeon
cytoreduction definitions (3pts) - OS depends on this
microscopic: no visible
optimal: 1cm
OS depends on this
role of adjuvant combination chemo -5
primary tx for ALL stages
LIMITED TO OVARY=STAGE 1
adjuvant chemo by stage - early stage I-II - comprehensive surgical staging -6
determined by stage AND histology= favorable vs unfavorable
adjuvant chemo - advanced dz (stage II-IV) NCCN regimens -6
SOME CALL THIS STAGE III-IV, but not NCCN
ALL CYCLES q21d x6
Dose dense study: pac 80 over 1h D1,8,15 +carbo 6 D1 (cat 1) vs pac/carbo D1 - adv dz JAPANESE -4
PFS 28 vs 17
Armstrong trial: IP chemo: pac 135 over 24h D1 +cis 75-100 IP D2 +pac 60 IP D8 (cat 1) vs pac 135 over 24h +cis 75 (this reg no longer used) - OPTIMAL, stage III -adv dz AND ADR -4
TOC: guidelines read offer to ALL pts who qualify
#IP arm significantly more toxic: (leukop, thrombocytop, GI, fatigue, metabolic, pain, fever, infx, renal)
IP chemo - pt selection - adv dz (5pts)
Stage IIIC, optimal, adjuvant
no rectosigmoid bowel resection at time of primary tx
none or minimal prior pelvic surgery (if lots of adhesions in bowel chemo does not distribute well)
good PS
<65 yo
GOG-218: pac 175 over 3h +carbo 6 +bev 7.5-15 add C2-6 +bev 7.5-15 q21d another 12-17C (cat 3) vs +bev for C2-6 only vs placebo bev for C2-6 - included SUBOPTIMAL, stage III-IV - adv dz
-6
PFS 14.1 vs 11.2 vs 10.3 (sig) (needed bev MAINTENANCE to see difference, can not give just C2-6)
which cycle can you start bev?
C2 (need time for surgery wound healing)
adjuvant chemo by stage - early stage I-II - inadequate surgical staging
chemo for ALL unlike comprehensive staging, IV or IP
recurrent dz - general principles (5pts)
60-80% relapse
when to initiate tx following CHEMICAL recurrence?
NCCN: follow CA-125 q3-4mo if elevated pre-op
prognosis and tx defined by initial response to tx
platinum/taxane sensitive: treatment free interval > 6mo
p/t resistant: TFI <6mo
p/t refractory: no response or progression on primary tx