Epithelial Cancer of Ovary, Fallopian Tube, and Primary Peritoneum Clinical Practice Guidelines (2019)

FRANCOGYN/CNGOF/SFOG/GINECO-ARCAGY

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

May 07, 2019

The guidelines on management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum were issued on March 29 and 30, 2019, by Groupe Français de Recherche en Chirurgie Oncologique et Gynécologique (FRANCOGYN), Collège National des Gynécologues Obstétriciens Français (CNGOF), Société Française d'Oncologie Gynécologique (SFOG), and Groupe d'Investigateurs Nationaux pour l'Étude des Cancers Ovariens et du Sein (GINECO)–Association de Recherche sur les Cancers dont Gynécologiques (ARCAGY), and endorsed by Institut National du Cancer (INCA).[1,2]

Magnetic resonance imaging (MRI) is recommended for an ovarian mass that is indeterminate on ultrasonography (US). The Ovarian Malignancy Risk Algorithm (ROMA) score (combining CA125 and HE4) can also be calculated.

In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: omentectomy (infracolic, at a minimum), appendectomy, multiple peritoneal biopsies, peritoneal cytology, and pelvic and para-aortic lymphadenectomies for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted.

Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture.

For Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage III or IV ovarian, tubal, and primary peritoneal cancers, contrast-enhanced computed tomography (CT) of the thorax/abdomen/pelvis is recommended, as well as laparoscopic exploration to take multiple biopsies and a carcinomatosis score (Fagotti score, at a minimum) to assess the possibility of complete surgery (ie, with no macroscopic tumor residue left).

Complete surgery via a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer.

For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected.

When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival.

Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue.

Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA).

After primary surgery is complete, six cycles of intravenous chemotherapy are recommended or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio.

After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OVHIPEC trial.

In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended.

For more information, please go to Ovarian Cancer, Malignant Lesions of the Fallopian Tube and Broad Ligament, and Peritoneal Cancer.

For more Clinical Practice Guidelines, please go to Guidelines.

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