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Original Abstract of the Article

Key Research Findings

Several studies have investigated various aspects of ovarian cancer treatment, including the effectiveness of different treatment options, side effects, and survival outcomes. 2 explored the challenges of prophylactic chemotherapy, second-look surgery, and remission maintenance in ovarian cancer treatment. They found that post-operative prophylactic chemotherapy is beneficial only for stage 1 and stage 2 ovarian cancers when tumor cells are detected in the pouch of Douglas or ascites, and when sensitivity to chemotherapy is anticipated. In about 50% of patients with initially inoperable stage 3 ovarian cancer, random treatment with cyclophosphamide (Endoxan) led to clinical remission. The study highlighted the importance of removing the uterus and adnexa for achieving a significant five-year cure rate. Moreover, radical surgery during remission appeared crucial for patient survival. They emphasized the need for continuous chemotherapy for at least two years following surgery and radiotherapy for remission maintenance. 87 focused on residual disease after primary surgery for advanced epithelial ovarian cancer. They discovered a strong association between macroscopic cytoreduction and improved overall survival (OS). Despite utilizing contemporary methodology, some skepticism remained about these findings. 4 provided a critical review of chemotherapy for advanced epithelial cancer. It highlighted the lack of direct evidence supporting chemotherapy’s ability to extend survival in patients with advanced carcinoma, excluding small-cell lung cancer. While some studies suggested potential benefits for ovarian and lung cancer patients, the therapeutic benefit was deemed minimal, and less aggressive treatment appeared equally effective. The authors acknowledged that specific subgroups might benefit from chemotherapy, but further research was needed to precisely identify these groups. The review also emphasized the lack of evidence supporting the notion that response to therapy directly correlates with prolonged survival, challenging common assumptions in the field. The review concluded that there was insufficient evidence to justify the use of chemotherapy in symptom-free patients with advanced epithelial malignancy, except in rare circumstances. 7 reviewed randomized clinical trials examining the role of platinum-based chemotherapy in advanced ovarian cancer, including single-agent and combination therapies. 66 compared the toxicities of various first-line chemotherapy regimens for advanced ovarian cancer using network meta-analysis. 57 advocated for intraperitoneal chemotherapy following cytoreductive surgery as the standard of care for advanced epithelial ovarian cancer. This approach demonstrated favorable oncologic outcomes in both clinical and preclinical settings. However, the study noted its underutilization despite the evidence. 48 explored the relationship between tumor biology and surgical success in epithelial ovarian cancer. The study found a significant correlation between progression-free survival, overall survival, and the success of surgery and residual disease volume. However, it remained unclear whether this survival advantage was attributed to intrinsic tumor cell biology facilitating successful surgery or simply the reduction of tumor-sustaining cells. 80 assessed the clinical benefit of systemic therapies for recurrent ovarian cancer using the European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS). The study focused on platinum-based chemotherapy and maintenance treatments for platinum-sensitive recurrent ovarian cancer, including bevacizumab and poly (ADP-ribose) polymerase inhibitors. It also evaluated non-platinum options for platinum-resistant disease. 67 evaluated the impact of ovarian cancer screening programs on clinical outcomes in asymptomatic women using meta-analysis. 41 compared ultra-radical (extensive) surgery and standard surgery for primary cytoreduction in advanced epithelial ovarian cancer. 35 reviewed factors predicting the outcome of cytoreductive surgery for advanced ovarian cancer. 56 investigated the optimal treatment for early-stage ovarian cancer. 23 conducted a systematic review of chemotherapy effects in ovarian cancer, analyzing data from over 33,000 patients. The review highlighted the effectiveness of paclitaxel/platinum combination therapy in advanced ovarian cancer compared to historical data. It also addressed the role of carboplatin as a potential substitute for cisplatin in paclitaxel-containing regimens. 49 investigated the use of chemotherapy and/or radiotherapy in conjunction with surgery for ovarian carcinosarcoma. The study acknowledged the mixed effectiveness of various treatment regimens for this rare type of ovarian cancer. It emphasized the need to determine optimal neoadjuvant or adjuvant therapy after surgical cytoreduction and to address quality-of-life issues related to treatment toxicity. 51 systematically reviewed the role of cytoreductive surgery in advanced-stage ovarian cancer, emphasizing its importance in achieving optimal cytoreduction and potentially improving overall survival. The review highlighted the need for patients to be referred to specialized centers for primary surgery. 22 compared the effectiveness of three cycles versus six cycles of adjuvant paclitaxel (Taxol)/carboplatin in high-risk patients with early-stage ovarian cancer. After a three-year follow-up, the study found that both treatment regimens resulted in similar rates of recurrence-free survival. However, the study observed higher rates of grade 3/4 leukopenia and grade 2-4 neurologic toxicity in the six-cycle group. 3 reported on the treatment of ovarian cancer. 82 systematically reviewed molecular methods for enhancing the effectiveness of ovarian cancer treatment, highlighting the potential of targeted therapies. 13 compared two combined treatment regimens for stage III-IV ovarian cancer, finding that surgical treatment at the initial stage yielded better results. 5 analyzed the long-term survival of advanced ovarian cancer patients in an Australian trial that compared combination versus sequential chlorambucil and cisplatin therapy. The study found no significant difference in survival between the two treatment arms. However, it highlighted the improved survival prospects of women with low-potential malignancy compared to those with invasive tumors. 8 explored the theoretical and experimental foundations of combined chemo- and hormone-therapy for advanced ovarian carcinoma, emphasizing the need for alternative therapies due to the frequent relapse and chemotherapy resistance. The study highlighted a new regimen combining Doxorubicin, Cisplatin, Vincristine, Cyclophosphamide, and Methotrexate (AP-VC-MTX) as a potential standard therapy for advanced ovarian cancer. It also explored the role of Medroxyprogesterone acetate (MPA) in hormone therapy. 37 focused on DNA-repair pathway inhibitors, particularly PARP inhibitors, as novel agents for treating ovarian cancer. The study recognized the need to assess the effectiveness and side effects of these novel agents compared to conventional chemotherapy to determine their role in advanced disease treatment. 47 investigated the impact of second to sixth-line therapy on the survival of relapsed ovarian cancer patients after primary taxane/platinum-based therapy. 19 presented findings on the treatment of ovarian cancer in elderly women from Mayo Clinic and North Central Cancer Treatment Group studies. 24 provided a rapid and systematic review of the clinical effectiveness and cost-effectiveness of topotecan for ovarian cancer. 54 examined the benefits of cytoreductive surgery followed by chemotherapy versus chemotherapy alone for recurrent platinum-sensitive epithelial ovarian cancer. The study, known as the SOCceR trial, highlighted the potential survival benefits of cytoreductive surgery in this patient group but acknowledged the lack of definitive level I-II evidence. 71 discussed epidermal growth factor receptor (EGFR) blockers as a novel therapeutic approach for ovarian cancer. 84 compared weekly and tri-weekly paclitaxel with carboplatin as first-line treatment for epithelial ovarian cancer. 42 evaluated follow-up strategies for patients with epithelial ovarian cancer after completing primary treatment. 69 investigated antigen-specific active immunotherapy as an alternative treatment for ovarian cancer. 43 explored the optimal primary surgical treatment for advanced epithelial ovarian cancer. 81 presented a randomized trial of cytoreductive surgery for relapsed ovarian cancer. 16 reported on a prospective study conducted by the Swiss Group for Clinical Cancer Research (SAKK) investigating chemo-(hormonal)-therapy for advanced ovarian neoplasms. 14 reviewed a randomized prospective therapeutic study investigating the impact of postoperative chemotherapy for early-stage ovarian cancer. 30 provided a systematic review of neoadjuvant chemotherapy and interval cytoreduction as alternative strategies for treating advanced-stage ovarian cancer. 58 investigated the effectiveness of follow-up strategies for patients with epithelial ovarian cancer. 27 assessed the clinical effectiveness of four primary treatment options for epithelial ovarian cancer: adjuvant chemotherapy and/or adjuvant radiotherapy, cytoreductive surgery, neoadjuvant chemotherapy for advanced disease, and postoperative chemotherapy for advanced disease. 1 examined the results of chemotherapy as an adjunct to surgery for localized ovarian cancer. 17 discussed the treatment strategy for ovarian cancer in Japan. 65 investigated whether ovarian cancer is a targetable disease using a systematic review, meta-analysis, and genomic data investigation.

Treatment Summary

2 explored the challenges of prophylactic chemotherapy, second-look surgery, and remission maintenance in ovarian cancer treatment. They found that post-operative prophylactic chemotherapy is beneficial only for stage 1 and stage 2 ovarian cancers when tumor cells are detected in the pouch of Douglas or ascites, and when sensitivity to chemotherapy is anticipated. In about 50% of patients with initially inoperable stage 3 ovarian cancer, random treatment with cyclophosphamide (Endoxan) led to clinical remission. The study highlighted the importance of removing the uterus and adnexa for achieving a significant five-year cure rate. Moreover, radical surgery during remission appeared crucial for patient survival. They emphasized the need for continuous chemotherapy for at least two years following surgery and radiotherapy for remission maintenance. 87 focused on residual disease after primary surgery for advanced epithelial ovarian cancer. They discovered a strong association between macroscopic cytoreduction and improved overall survival (OS). 4 reviewed chemotherapy for advanced epithelial cancer and concluded that there was insufficient evidence to justify the use of chemotherapy in symptom-free patients with advanced epithelial malignancy, except in rare circumstances. 7 reviewed randomized clinical trials examining the role of platinum-based chemotherapy in advanced ovarian cancer, including single-agent and combination therapies. 66 compared the toxicities of various first-line chemotherapy regimens for advanced ovarian cancer using network meta-analysis. 57 advocated for intraperitoneal chemotherapy following cytoreductive surgery as the standard of care for advanced epithelial ovarian cancer. 48 explored the relationship between tumor biology and surgical success in epithelial ovarian cancer. 80 assessed the clinical benefit of systemic therapies for recurrent ovarian cancer. 67 evaluated the impact of ovarian cancer screening programs. 41 compared ultra-radical (extensive) surgery and standard surgery for primary cytoreduction in advanced epithelial ovarian cancer. 35 reviewed factors predicting the outcome of cytoreductive surgery for advanced ovarian cancer. 56 investigated the optimal treatment for early-stage ovarian cancer. 23 reviewed chemotherapy effects in ovarian cancer, analyzing data from over 33,000 patients. The review highlighted the effectiveness of paclitaxel/platinum combination therapy in advanced ovarian cancer compared to historical data. It also addressed the role of carboplatin as a potential substitute for cisplatin in paclitaxel-containing regimens. 49 investigated the use of chemotherapy and/or radiotherapy in conjunction with surgery for ovarian carcinosarcoma. 51 systematically reviewed the role of cytoreductive surgery in advanced-stage ovarian cancer, emphasizing its importance in achieving optimal cytoreduction and potentially improving overall survival. 22 compared the effectiveness of three cycles versus six cycles of adjuvant paclitaxel (Taxol)/carboplatin in high-risk patients with early-stage ovarian cancer. 3 reported on the treatment of ovarian cancer. 82 systematically reviewed molecular methods for enhancing the effectiveness of ovarian cancer treatment. 13 compared two combined treatment regimens for stage III-IV ovarian cancer. 5 analyzed the long-term survival of advanced ovarian cancer patients. 8 explored the theoretical and experimental foundations of combined chemo- and hormone-therapy for advanced ovarian carcinoma. 37 focused on DNA-repair pathway inhibitors, particularly PARP inhibitors, as novel agents for treating ovarian cancer. 47 investigated the impact of second to sixth-line therapy on the survival of relapsed ovarian cancer patients. 19 presented findings on the treatment of ovarian cancer in elderly women. 24 provided a rapid and systematic review of the clinical effectiveness and cost-effectiveness of topotecan for ovarian cancer. 54 examined the benefits of cytoreductive surgery followed by chemotherapy versus chemotherapy alone. 71 discussed epidermal growth factor receptor (EGFR) blockers as a novel therapeutic approach. 84 compared weekly and tri-weekly paclitaxel with carboplatin as first-line treatment for epithelial ovarian cancer. 42 evaluated follow-up strategies for patients with epithelial ovarian cancer. 69 investigated antigen-specific active immunotherapy as an alternative treatment for ovarian cancer. 43 explored the optimal primary surgical treatment for advanced epithelial ovarian cancer. 81 presented a randomized trial of cytoreductive surgery for relapsed ovarian cancer. 16 reported on a prospective study investigating chemo-(hormonal)-therapy for advanced ovarian neoplasms. 14 reviewed a randomized prospective therapeutic study investigating the impact of postoperative chemotherapy for early-stage ovarian cancer. 30 provided a systematic review of neoadjuvant chemotherapy and interval cytoreduction. 58 investigated the effectiveness of follow-up strategies. 27 assessed the clinical effectiveness of four primary treatment options for epithelial ovarian cancer. 1 examined the results of chemotherapy as an adjunct to surgery. 17 discussed the treatment strategy for ovarian cancer in Japan. 65 investigated whether ovarian cancer is a targetable disease.

Benefits and Risks

Benefits Summary

Benefits associated with ovarian cancer treatment include prolonged survival, reduced risk of cancer recurrence, and improved quality of life. 2 highlighted the importance of removing the uterus and adnexa for achieving a significant five-year cure rate. Moreover, radical surgery during remission appeared crucial for patient survival. They emphasized the need for continuous chemotherapy for at least two years following surgery and radiotherapy for remission maintenance. 87 discovered a strong association between macroscopic cytoreduction and improved overall survival (OS). 57 advocated for intraperitoneal chemotherapy following cytoreductive surgery as the standard of care for advanced epithelial ovarian cancer.

Risks Summary

Ovarian cancer treatment carries risks of side effects. Chemotherapy side effects include nausea, vomiting, hair loss, bone marrow suppression, and nerve damage. 23 listed common chemotherapy side effects. 66 compared toxicities of various first-line chemotherapy regimens for advanced ovarian cancer. Surgical risks include bleeding, infection, and organ damage. Radiotherapy side effects include nausea, vomiting, skin irritation, and fatigue.

Comparison of Studies

Commonalities

Studies on ovarian cancer treatment commonly focus on evaluating the effectiveness and side effects of treatments like surgery, chemotherapy, and radiotherapy. They also investigate factors predicting treatment outcomes, recognizing the significant impact of tumor stage on prognosis. Many studies acknowledge the challenges posed by late diagnosis, often resulting in advanced-stage disease.

Differences

Studies on ovarian cancer treatment vary in their approach, considering different types and stages of ovarian cancer, treatment methods, and evaluation criteria. 2 focused on the challenges of prophylactic chemotherapy, second-look surgery, and remission maintenance. 87 investigated residual disease after primary surgery. 57 advocated for intraperitoneal chemotherapy. 23 systematically reviewed chemotherapy effects. 66 compared toxicities of various first-line chemotherapy regimens. These diverse approaches highlight the ongoing research efforts to understand ovarian cancer treatment better and develop more effective therapies.

Consistency and Inconsistencies in Findings

Research on ovarian cancer treatment reveals both consistent and inconsistent findings. For example, there is variability in the reported effectiveness of chemotherapy. 4 highlighted the lack of direct evidence supporting chemotherapy’s ability to extend survival in patients with advanced carcinoma, excluding small-cell lung cancer. However, 23 showed that paclitaxel/platinum combination therapy significantly improved survival compared to historical data. These disparities suggest the need for cautious consideration of treatment options based on individual patient characteristics. The diverse outcomes highlight the complex nature of ovarian cancer and the need for continued research to understand treatment responses better.

Considerations for Practical Application

When applying research findings to real-world treatment, it is crucial to remember that not all research results are universally applicable. Individual patient factors, such as age, health status, and lifestyle, can influence treatment outcomes and side effects. Consult with a doctor to choose a treatment plan that aligns with your specific situation. Furthermore, research findings might not always reflect the most up-to-date treatments. New therapies and technologies are continuously emerging, so staying informed about the latest advancements and consulting with a doctor for guidance is essential.

Limitations of Current Research

Research on ovarian cancer treatment faces several limitations. Many studies suffer from small sample sizes, which can limit the generalizability of their findings. The heterogeneity of patient characteristics across different studies can make it challenging to compare and interpret results accurately. Additionally, individual variations in tumor biology and responses to treatment make finding a universally effective therapy difficult.

Future Research Directions

To advance research on ovarian cancer treatment further, several key research directions are crucial. Conducting larger clinical trials with larger sample sizes is critical to enhance the generalizability of research findings. Developing tailored treatment plans for different ovarian cancer types and stages is necessary to optimize treatment selection for individual patients. Understanding the mechanisms driving ovarian cancer development is essential for developing new treatment and prevention strategies.

Conclusion

Research on ovarian cancer treatment has made significant progress, but many challenges remain. Continuous research is necessary to develop more effective and safer treatment options for patients. If diagnosed with ovarian cancer, consulting with a doctor and considering the latest treatment information is essential for informed decision-making. Advocating for continued research investment and supporting ongoing efforts to improve ovarian cancer treatment is crucial.

List of Treatment Keywords

Prophylactic chemotherapy, second-look surgery, remission maintenance, cytoreductive surgery, intraperitoneal chemotherapy, chemotherapy, radiotherapy, neoadjuvant chemotherapy, hormone therapy, DNA repair pathway inhibitors, targeted therapy, immunotherapy


Keywords
Benefit Keywords
Risk Keywords
Literature analysis of 87 papers
Positive Content
83
Neutral Content
3
Negative Content
1
Article Type
29
27
52
47
87

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Author: HarterPhilipp, SehouliJalid, VergoteIgnace, FerronGwenael, ReussAlexander, MeierWerner, GreggiStefano, MosgaardBerit J, SelleFrederic, GuyonFrédéric, PomelChristophe, LécuruFabrice, ZangRongyu, Avall-LundqvistElisabeth, KimJae-Weon, PonceJordi, RaspagliesiFrancesco, KristensenGunnar, ClasseJean-Marc, HillemannsPeter, JensenPernille, HasenburgAnnette, Ghaem-MaghamiSadaf, MirzaMansoor R, LundBente, ReinthallerAlexander, SantaballaAna, OlaitanAdeola, HilpertFelix, du BoisAndreas,


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