Diagnostic and Therapeutic Pathway of Advanced Ovarian Cancer with Peritoneal Metastases

SIMPLE SUMMARY: As ovarian cancer represents the most lethal gynecological malignancy, the diagnostic process represents a crucial step in order to select the appropriate treatment strategy. Indeed, the association of tumor marker levels with radiological imaging and an evaluation of tumor load with diagnostic laparoscopy are essential to assess whether the patients are best treated by upfront surgery or neo-adjuvant chemotherapy followed by interval debulking surgery. With this review, we aim to provide most relevant available evidence on the diagnostic and treatment pathway of advanced ovarian cancer. ABSTRACT: Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis. In this scenario, standard treatment includes a combination of cytoreductive surgery and carboplatinum–paclitaxel-based chemotherapy. Despite the survival advantage of patients treated with upfront cytoreductive surgery compared to women undergoing neo-adjuvant chemotherapy (NACT) and interval debulking surgery (IDS) due to high tumor load or poor performance status has been demonstrated by multiple studies, this topic is still a matter of debate. As a consequence, selecting the adequate treatment through an appropriate diagnostic pathway represents a crucial step. Aiming to assess the likelihood of leaving no residual disease at the end of surgery, the role of the CT scan as a predictor of cytoreductive outcomes has shown controversial results. Similarly, CA 125 level as an expression of tumor load demonstrated limited applicability. On the contrary, laparoscopic assessment of disease distribution through a validated scoring system was able to identify, with the highest specificity, patients undergoing suboptimal cytoreduction and therefore best suitable for NACT-IDS. Against this background, with this article, we aim to provide a comprehensive review of available evidence on the diagnostic and treatment pathways of advanced ovarian cancer.