Treatment strategies for oligometastatic and oligorecurrent epithelial ovarian cancer: a narrative review

Recurrent epithelial ovarian, fallopian tube, and primary peritoneal carcinoma is usually managed as a systemic disease, yet some patients present with limited-volume recurrent, persistent, or progressive disease that appears amenable to local treatment. This clinical state is variably described as oligometastatic, oligorecurrent, oligoprogressive, or locoregional recurrence. Whether it represents a distinct biologic state, a radiologically defined disease pattern detected by modern imaging, a treatment-selection construct, or a mixture of these remains un-resolved. The issue has become more clinically relevant because advances in systemic and maintenance therapy, imaging, supportive care, and selected use of surgery have extended survival and increased detection of limited-site recurrence. This narrative review evaluates evidence for secondary cytoreductive surgery or metastasectomy, stereotactic body radiotherapy, and image-guided ablation in oligometastatic or oligorecurrent epithelial ovarian cancer, with systemic therapy considered as the therapeutic context in which local treatment is selected. Its objective is to clarify the populations, end points, and limitations of each evidence base to support individualized multi-disciplinary decision-making. The evidence is not directly comparable: randomized surgical trials enrolled selected patients with platinum-sensitive, resectable recurrence rather than uniformly defined oligometastatic disease; stereotactic body radiotherapy studies selected technically treatable lesions, often nodal; and ablation reports are small, liver-predominant, and mostly retrospective. Surgery is the only local modality tested in phase 3 randomized trials, whereas stereotactic body radiotherapy and ablation primarily demonstrate treated-lesion control and, in selected cohorts, delay to the next systemic regimen; patient-level survival benefit remains unproven. Decisions should integrate histotype, platinum sensitivity, prior systemic and maintenance therapy, lesion number and distribution, technical feasibility and morbidity, symptoms, quality-of-life priorities, and patient preference.