ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease

Abstract

The development of guidelines is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO–ESGO consensus conference on ovarian cancer was held on April 12–14, 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO–ESGO consensus conference, together with a summary of evidence supporting each recommendation.

Management of ovarian cancer during the COVID‐19 pandemic

“…Although NACT reduces the risk of postsurgical death and serious infection, it is still necessary to consider the fragility of the patient undergoing chemotherapy. We well know the benefit of upfront surgery on survival and that it is preferable to NACT in otherwise healthy women; however, depriving a patient of respiratory assistance would mean certain death. Decisions on where to allocate resources is becoming a daily dilemma.…”

Ovarian cancer surgery

“…Role of minimally invasive surgery In early stage disease, surgical staging with adjuvant chemotherapy is standard of care. According to the ESMO and ESGO guidelines, laparotomy is recommended as a surgical approach to minimize the potential risk of tumour rupture [8]. In early stage disease in particular, several approaches have been made to introduce minimally invasive surgery as staging method [9].…”

How to manage lymph nodes in ovarian cancer

“…Because completely staged FIGO I ovarian cancer is often treated with carboplatin monotherapy, at least a combination of carboplatin and paclitaxel is indicated in patients with upstaging by lymph node metastases. 19 This discussion also includes frail patients in whom combination chemotherapy is not feasible and for whom, therefore, surgical detection of microscopic metastases is not indicated. 18 Some centers recommend a combination of carboplatin and paclitaxel for all patients with an indication for chemotherapy and also for patients with FIGO I early-stage ovarian cancer.…”

“…The recently published European Society of Gynaecological Oncology-European Society for Medical Oncology consensus reflects this heterogeneity within countries. 19 This discussion also includes frail patients in whom combination chemotherapy is not feasible and for whom, therefore, surgical detection of microscopic metastases is not indicated. Because the historical standard is staging lymphadenectomy followed by chemotherapy, which is determined by the final lymph node and BRCA status, the blind recommendation to treat all patients with 6 cycles of a combination of carboplatin and paclitaxel instead of staging lymphadenectomy is to our knowledge an unproven concept.…”