Management of Recurrence in Ovarian Cancer-The Role of Surgery and HIPEC with Relevance to BRCA Testing in a PARPi...

Background: The surgical and medical management of recurrent ovarian cancer is complex and requires a personalized approach based on several factors, including the timing of recurrence, the patient's performance status, previous treatment regimens, and the tumor's histology and molecular characteristics. Objectives: Five randomized trials-GOG-0213, DESKTOP III, SOC 1, HORSE, and CHIPOR-have been conducted and shed light on our practice. Results: Both the DESKTOP III and the SOC 1 trials support the benefit of secondary surgery. The GOG-0213 trial, however, did not show an overall survival benefit, confirming that surgery should not be offered to all patients with platinum-sensitive recurrent ovarian cancer and highlighting the importance of strict patient selection using evidence-based selection criteria including the AGO or iMODEL scores. In patients with a negative score, there may be a place for cytoreductive surgery plus HIPEC in BRCA-negative cases following a course of chemotherapy, although current evidence shows no additional benefit for HIPEC when cytoreductive surgery is performed as an adjuvant procedure. Conclusions: Secondary surgery is recommended for platinum-sensitive patients when respecting AGO or iModel criteria. In addition, surgery plus HIPEC can be considered in BRCA-negative patients with an initial negative AGO or iMODEL score who show sufficient response following a course of neoadjuvant chemotherapy to then be considered operable.