Surgery: The Foundation of Ovarian Cancer Treatment
Surgery is the cornerstone of ovarian cancer management. The goal is complete cytoreduction (R0) — removal of all macroscopic tumour. This typically involves total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy and resection of all visible peritoneal implants. Complete cytoreduction is the strongest predictor of survival.
HIPEC in Ovarian Cancer
Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery delivers cisplatin directly into the peritoneal cavity at 41–43°C after surgical cytoreduction. The OVHIPEC trial demonstrated improved progression-free and overall survival when HIPEC was added to interval cytoreductive surgery in stage III ovarian cancer. Its role in primary surgery is being established in ongoing trials.
Systemic Chemotherapy
Standard first-line regimen: carboplatin + paclitaxel for 6 cycles, administered intravenously. Can be given before (neoadjuvant/NACT) or after surgery. NACT with interval debulking surgery is preferred when upfront complete cytoreduction is not feasible. Addition of bevacizumab improves progression-free survival in high-risk patients.
PARP Inhibitors: A Major Advance
PARP inhibitors (olaparib, niraparib, rucaparib) have transformed maintenance therapy for ovarian cancer. Patients with BRCA1/2 mutations benefit most. Olaparib + bevacizumab maintenance significantly improves progression-free survival in HRD-positive tumours. Standard testing for BRCA mutations and homologous recombination deficiency (HRD) status is now routine.
Second-Line Treatment and Beyond
Treatment choice depends on platinum-free interval: platinum-sensitive recurrence (>6 months) benefits from platinum re-challenge. Platinum-resistant recurrence requires non-platinum agents (pegylated liposomal doxorubicin, gemcitabine, weekly paclitaxel). Clinical trials for immunotherapy and other novel agents are available. Secondary cytoreductive surgery in selected platinum-sensitive recurrences (DESKTOP III criteria).
Do you have ovarian cancer requiring specialist management? At Quenet Torrent Institute we are experts in ovarian cancer surgery including cytoreductive surgery with HIPEC. Request a consultation.