Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Short text of the French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa
Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Short text of the French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa
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DOI：
10.1016/j.ejogrb.2019.03.010
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发表时间：
2019-05-01
影响因子：
2.6
通讯作者：
Darai, E.
中科院分区：
文献类型：
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作者：
Lavoue, V.;Huchon, C.;Darai, E.
对于超声检查不确定的卵巢肿块，建议进行MRI。还可以计算ROMA评分（结合CA 125和HE 4）（A级）。在假定的早期卵巢癌或输卵管癌中，应进行以下手术：网膜切除术（至少，结肠下），阑尾切除术，多处腹膜活检，腹膜细胞学检查（C级），盆腔和腹主动脉旁淋巴结切除术（B级），所有组织学类型，除了可省略淋巴结切除术（C级）的膨胀性粘液亚型。对于早期卵巢癌，当没有肿瘤破裂的风险时（B级），建议进行微创手术。推荐卡铂和紫杉醇辅助化疗用于所有高级别卵巢癌和输卵管癌（FIGO I-IIA期）（A级）。对于FIGO III或IV期卵巢癌、输卵管癌和原发性腹膜癌，建议进行胸部/腹部/骨盆的对比增强计算机断层扫描（CT）扫描（B级），以及腹腔镜探查以进行多次活检（A级）和癌病评分（最低Fagotti评分）（C级），以评估完全手术的可能性（即，没有留下肉眼可见的肿瘤残留物）。对于晚期卵巢癌、输卵管癌或原发性腹膜癌（B级），建议采用中线剖腹术进行完整手术。对于晚期癌症，当临床或放射学怀疑有转移性淋巴结病（B级）时，建议行主动脉旁和盆腔淋巴结切除术。当不怀疑淋巴结肿大时，如果晚期癌症的初次手术是完全腹膜手术，则可以省略淋巴结切除术，因为它们不会改变药物治疗或总生存率（B级）。初次手术（在其他治疗之前）是推荐的，只要它似乎可能不会留下肿瘤残留（B级）。初次手术完成后，建议进行6个周期的静脉化疗（A级），或根据患者的风险-受益比与患者讨论腹腔化疗。在FIGO III期疾病的完全间隔手术后，可根据OV-HIPEC试验的模式（B级）建议进行腹腔热化疗（HIPEC）。在术后肿瘤残留或FIGO IV期肿瘤的情况下，建议使用贝伐珠单抗联合化疗（A级）。(C)2019 Elsevier B. V.版权所有。
An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (Grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and paraaortic lymphadenectomies (Grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). For FIGO stage III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (Grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancers (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). 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 (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) 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 disease, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A). (C) 2019 Elsevier B.V. All rights reserved.