The road to long-term survival: Surgical approach and longitudinal treatments of long-term survivors of advanced-stage serous ovarian cancer

Importance of Surgical Treatment in Ovarian Neoplasm

“…However, it is clearly proven that patients undergoing optimal surgical cytoreduction, followed by adjuvant chemotherapy, have a 5-year survival rate higher than patients who initially underwent adjuvant chemotherapy and then interval surgery [11]. Even if aggressive surgical treatment is performed, optimal primary debulking, preservation of sensitivity to chemotherapy It cannot certify a favorable prognosis, but the bio-humoral characteristics of the tumor type can greatly influence the long-term postoperative evolution, so that favorable evolution can be justified following some advancing staging [12]. In a recently published study, it was found that the combination of Paclitaxel with hyperthermic chemotherapy following interval cytoreduction is a feasible therapeutic protocol for advanced ovarian cancer [13].…”

Standard primary cytoreduction surgery (CRS) procedure for ovarian cancer (FIGO Stage IIB-IV)

“…Another reason to leave no tumor residue behind is related with the effectiveness of upfront chemotherapy, which are nearly ineffective eradicating tumor nodules larger than 2.5 mm 4 . The progression-free survival (PFS) and overall survival (OS) after complete/ ultra-radical CRS is significantly longer than the simple CRS 5 . This article is the review of the complete procedure/technique of ultra-radical CRS we currently are using in our Gynecologic Oncology Center.…”

Flow-induced Shear Stress Confers Resistance to Carboplatin in an Adherent Three-Dimensional Model for Ovarian Cancer: A Role for EGFR-Targeted Photoimmunotherapy Informed by Physical Stress

“…Ovarian cancer disseminates as individual cells or cell-clusters that exfoliate from the primary tumor and spread via transcoelomic, lymphatic, or hematogenous routes to distant sites [3][4][5][6][7][8][9][10]. Among these routes, transcoelomic metastases are the most common and are associated with the frequent production of malignant ascites as well as the highest morbidity and mortality rates [3,4].…”

“…Malignant ascites provide fluid-based routes for exfoliated tumor clusters and cells to spread throughout the peritoneum, as well as a nutrient-and chemokine-rich environment to promote the growth and motility of cancer cells [3][4][5]. Establishment of metastatic colonies in the peritoneum has a significant negative impact on survival outcomes and makes the disease exceptionally difficult to treat, with frequent recurrence [2,8,9,[11][12][13][14]. Studies have shown that ascites contribute to tumor heterogeneity, modulate the expression of integrins, and alter the activity of matrix-degrading enzymes in ovarian cancer [5,11,[15][16][17].…”

“…In addition to providing a cell-and protein-rich environment for cancer growth and progression, ascitic fluid also confers physical stress, such as flow-induced shear stress, on tumors [18][19][20][21][22][23][24][25][26]. Natural currents of ascitic fluid result, in part, from organ mobility, changes in negative subdiaphragmatic pressure, gravity, and recesses formed by Ovarian cancer disseminates as individual cells or cell-clusters that exfoliate from the primary tumor and spread via transcoelomic, lymphatic, or hematogenous routes to distant sites [3][4][5][6][7][8][9][10]. Among these routes, transcoelomic metastases are the most common and are associated with the frequent production of malignant ascites as well as the highest morbidity and mortality rates [3,4].…”