S3-Guideline on Diagnostics, Therapy and Follow-up of Malignant Ovarian Tumours

1 Information about this Short Version

1.1 Editors

German Guideline Programme in Oncology (OL) of the Association of the Scientific Medical Societies in Germany (AWMF), the German Cancer Society (DKG) and German Cancer Aid (DKH).

1.2 Leading professional society

Germany Society for Gynaecology and Obstetrics (DGGG).

1.3 Funding

This guideline was funded by German Cancer Aid as part of the German Guideline Programme in Oncology.

1.4 Contact

Office of the German Guideline Programme in Oncology

c/o Deutsche Krebsgesellschaft e. V.

Kuno-Fischer-Straße 8

14 057 Berlin, Germany

[e-mail]

www.leitlinienprogramm-onkologie.de

1.5 Citation

The German Guideline Programme in Oncology (German Cancer Society, German Cancer Aid, AWMF): S3-Guideline on Diagnostics, Therapy and Follow-up of Malignant Ovarian Tumors, short version 1.0 (2013), AWMF registration number: 032–035OL, http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html

1.6 Note

Medicine is continually subject to a process of development and change so that all information, particularly all information on diagnostic and therapeutic treatments, can only reproduce the state of knowledge at the time of printing of this guideline on care. The greatest possible care was taken when compiling these recommendations on therapy and the choice and dosage of medications. Users are requested to consult the package leaflets and check the summary of product characteristics provided by manufacturers and, when in doubt, to consult a specialist. In the interests of all concerned, please contact the OL editorial office if you find discrepancies or controversial issues. Users are responsible for all diagnostic and therapeutic applications, medications and dosages.

Registered trademarks (brand names) mentioned in this guideline have not been specifically labelled. When a specific indication lacks a trade name it should not be concluded that the brand name has not been registered. This guideline and all of its constituent parts is protected under copyright law. Any utilisation contrary to the provisions of copyright law without the written permission of the OL editorial office is prohibited and liable to prosecution. No part of this guideline may be reproduced in any form without the written permission of the OL editorial office. This applies in particular to copies, translations, microfilms and all storage, utilization and processing in electronic systems, intranets and the internet.

1.7 Additional guideline documents

The contents of this short version refer to the long version of the S3-Guideline on Diagnostics, Therapy and Follow-up of Malignant Ovarian Tumours available in German on the following websites

• AWMF (http://www.awmf.org/leitlinien/aktuelle-leitlinien.html)

• German Guideline Programme in Oncology http://www.leitlinienprogramm-onkologie.de/OL/leitlinien.html

• German Cancer Society http://www.krebsgesellschaft.de/wub_llevidenzbasiert,120884.html

• German Cancer Aid (http://www.krebshilfe.de/)

• Guidelines International Network (www.g-i-n.net)

• Contributing German scientific medical societies (e.g. http://www.dggg.de/leitlinien/)

In addition to the short version, a number of other, supplementary documents are also available:

• Guideline report on the compilation of the guideline

• Long version

• Patient guideline

All of these documents will also be available on the websites listed above.

1.8 Responsibilities

1.8.1 Authors of the guideline

Editorial team

• Prof. Dr. Uwe Wagner (Co-ordinator, DGGG), Uni-Frauenklinik, Baldingerstraße, 35 043 Marburg, Germany

• Dr. Philipp Harter (DGGG), Kliniken Essen-Mitte, Henricistraße 92, 45 136 Essen, Germany

• PD Dr. Felix Hilpert (DGGG), Universitätsklinikum Schleswig Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Arnold-Heller-Straße 3, Haus 24, 24 105 Kiel, Germany

• PD Dr. Sven Mahner (DGGG), Universitätsklinikum Hamburg-Eppendorf, Klinik für Gynäkologie, Martinistraße 52, 20 246 Hamburg, Germany

• Alexander Reuß, Koordinierungszentrum für Klinische Studien, Philipps-Universität Marburg, Karl-von Frisch-Straße 4, 35 043 Marburg, Germany

Participating scientific societies and authors

• Prof. Dr. Andreas du Bois – Arbeitsgemeinschaft Gynäkologische Onkologie e. V. (AGO) [Gynaecological Oncology Working Group]

• Prof. Dr. Edgar Petru – Arbeitsgemeinschaft für Gynäkologische Onkologie Austria (AGO AT) [Gynaecological Oncology Working Group Austria]

• Prof. Dr. Werner Meier – AGO Study Group

• Dr. Petra Ortner – Arbeitsgemeinschaft Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin (ASORS) [Working Group for Supportive Measures in Oncology, Rehabilitation and Epidemiology]

• Dr. Klaus König – Berufsverband der Frauenärzte e. V. (BVF) [Professional Organisation of German Gynaecologists]

• PD Dr. Katja Lindel – Deutsche Gesellschaft für Radioonkologie (DEGRO) [German Society for Radio-oncology]

• Prof. Dr. Dieter Grab – Deutsche Gesellschaft für Ultraschall in der Medizin e. V. (DEGUM) [German Society for Ultrasound in Medicine]

• Prof. Dr. Pompiliu Piso – Deutsche Gesellschaft für Allgemein- u. Viszeralchirurgie (DGAV) [German Society for General and Abdominal Surgery]

• Prof. Dr. Olaf Ortmann – Deutsche Gesellschaft für Endokrinologie (DGE) [German Society for Endocrinology]

• Prof. Dr. Ingo Runnebaum – Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) [Germany Society for Gynaecology and Obstetrics]

• Prof. Dr. Jacobus Pfisterer – Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) [Germany Society for Gynaecology and Obstetrics]

• PD Dr. Diana Lüftner – Deutsche Gesellschaft f. Hämatologie und Onkologie e. V. (DGHO) [German Society for Haematology and Oncology]

• Prof. Dr. Norbert Frickhofen – Deutsche Gesellschaft für Innere Medizin e. V. (DEGIM) [German Society for Internal Medicine]

• Prof. Dr. Frank Grünwald – Deutsche Gesellschaft für Nuklearmedizin e. V. (DGN) [German Society for Nuclear Medicine]

• Dr. Bernd Oliver Maier – Deutsche Gesellschaft für Palliativmedizin e. V. (DGP) [German Society for Palliative Medicine]

• Prof. Dr. Joachim Diebold, Prof. Dr. Steffen Hauptmann, Prof. Dr. Friedrich Kommoss – Deutsche Gesellschaft für Pathologie e. V. (DGP) [German Pathology Society]

• Prof. Dr. Günter Emons – Deutsche Menopausengesellschaft e. V. (DMG) Deutsche Gesellschaft für Pathologie [German Pathology Society]

• Dr. Boris Radeleff – Deutsche Röntgengesellschaft (DRG) [German Radiology Society]

• Marion Gebhardt (patientsʼ representative) – Bundesverband der Frauenselbsthilfe nach Krebs e. V. [Federation of Womenʼs Self-help after Cancer Organisations]

• Prof. Dr. Norbert Arnold – Deutsche Gesellschaft für Humangenetik (GfH) [German Society for Human Genetics]

• Dr. Gabriele Calaminus – Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) [Society for Paediatric Oncology and Haematology]

• Isolde Weisse – Konferenz Onkologischer Kranken- und Kinderkrankenpflege (KOK) [Conference for Oncologic Patient Care and Paediatric Patient Care]

• Prof. Dr. Joachim Weis – Arbeitsgemeinschaft für Psychosoziale Onkologie (PSO) [Psycho-social Oncology Working Group]

• Prof. Dr. Jalid Sehouli – Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie (NOGGO) [Northeast German Society for Gynaecological Oncology]

• Prof. Dr. Daniel Fink – Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) [Swiss Society for Gynaecology and Obstetrics]

• Dr. Alexander Burges – as an independent expert

• Prof. Dr. Annette Hasenburg – as an independent expert

• Dr. C. Eggert from the Medizinischen Dienst der Krankenversicherung in Hessen (MDK Hessen) [Medical Service of the Health Insurance Companies in Hesse] contributed to the discussions at the Consensus Conferences as an expert without voting rights.

Methodological Support

1. The German Guideline Programme on Oncology

   • Prof. Dr. Ina Kopp, Marburg (AWMF)

   • Dr. Markus Follmann MPH MSc, Berlin (DKG) [German Cancer Society]

   • Dipl.-Soz.Wiss Thomas Langer (DKG) [German Cancer Society]

2. External agencies:

3. Coordination Centre for Clinical Studies of Philipps University Marburg, A. Reuß, Dr. D. Lubbe

4. Bremen Institute for Prevention Research and Epidemiology (BIPS), Dr. K. Giersiepen

5. The leading professional society:

6. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) [German Society for Gynaecology and Obstetrics], Prof. Dr. R. Kreienberg

• 16 References

• 1 Scottish Intercollegiate Guidelines Network. SIGN #75: Epithelial ovarian cancer. A national clinical guideline. Scottish Intercollegiate Guidelines Network; 2003
• 2 The Australian Cancer Network and National Breast Cancer Centre. Clinical practice guidelines for the management of women with epithelial ovarian cancer. Camperdown, NSW: National Breast Cancer Centre; 2004
• 3 Menon U et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009; 10: 327-340
• 4 Kobayashi H et al. A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer 2008; 18: 414-420
• 5 Buys SS et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 2011; 305: 2295-2303
• 6 Fung MF et al. Screening postmenopausal women for ovarian cancer: a systematic review. J Obstet Gynaecol Can 2004; 26: 717-728
• 7 van Nagell Jr. JR et al. Long-term survival of women with epithelial ovarian cancer detected by ultrasonographic screening. Obstet Gynecol 2011; 118: 1212-1221
• 8 Timmerman D et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol 2008; 31: 681-690
• 9 Timmerman D et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 2000; 16: 500-505
• 10 Karlan BY et al. Peritoneal serous papillary carcinoma, a phenotypic variant of familial ovarian cancer: implications for ovarian cancer screening. Am J Obstet Gynecol 1999; 180: 917-928
• 11 Moller P et al. The BRCA1 syndrome and other inherited breast or breast-ovarian cancers in a Norwegian prospective series. Eur J Cancer 2001; 37: 1027-1032
• 12 Taylor L, Schwarz H. Identification of a soluble OX40 isoform: development of a specific and quantitative immunoassay. J Immunol Methods 2001; 255: 67-72
• 13 van der Velde NM et al. Time to stop ovarian cancer screening in BRCA1/2 mutation carriers?. Int J Cancer 2009; 124: 919-923
• 14 Rustin GJ et al. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC55955): a randomised trial. Lancet 2010; 376: 1155-1163
• 15 Forstner R et al. ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol 2010; 20: 2773-2780
• 16 Peng NJ et al. Early detection of recurrent ovarian cancer in patients with low-level increases in serum CA-125 levels by 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography. Cancer Biother Radiopharm 2011; 26: 175-181
• 17 Gu P et al. CA 125, PET alone, PET-CT, CT and MRI in diagnosing recurrent ovarian carcinoma: a systematic review and meta-analysis. Eur J Radiol 2009; 71: 164-174
• 18 Partridge EE, Barnes MN. Epithelial ovarian cancer: prevention, diagnosis, and treatment. CA Cancer J Clin 1999; 49: 297-320
• 19 ESMO. ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of ovarian cancer. Ann Oncol 2001; 12: 1205-1207
• 20 Jacobs I, Bast Jr. RC. The CA 125 tumour-associated antigen: a review of the literature. Hum Reprod 1989; 4: 1-12
• 21 IQWIG. Positronenemissionstomographie (PET) und PET/CT bei Ovarialkarzinom. 2011. http://www.iqwiq.de
• 22 Torizuka T et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D-glucose. Eur J Nucl Med Mol Imaging 2002; 29: 797-803
• 23 Takekuma M et al. Positron emission tomography with 18F-fluoro-2-deoxyglucose for the detection of recurrent ovarian cancer. Int J Clin Oncol 2005; 10: 177-181
• 24 Rebbeck TR et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002; 346: 1616-1622
• 25 Kauff ND et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2002; 346: 1609-1615
• 26 Haber D. Prophylactic oophorectomy to reduce the risk of ovarian and breast cancer in carriers of BRCA mutations. N Engl J Med 2002; 346: 1660-1662
• 27 Finch A et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation. JAMA 2006; 296: 185-192
• 28 Rebbeck TR et al. PROSE Study Group. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2005; 23: 7804-7810
• 29 Madalinska JB et al. The impact of hormone replacement therapy on menopausal symptoms in younger high-risk women after prophylactic salpingo-oophorectomy. J Clin Oncol 2006; 24: 3576-3582
• 30 Parker WH et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nursesʼ health study. Obstet Gynecol 2009; 113: 1027-1037
• 31 Madalinska JB et al. Quality-of-life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. J Clin Oncol 2005; 23: 6890-6898
• 32 Wagner TM et al. Attitude towards prophylactic surgery and effects of genetic counselling in families with BRCA mutations. Austrian Hereditary Breast and Ovarian Cancer Group. Br J Cancer 2000; 82: 1249-1253
• 33 Hallowell N. A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy. Psychooncology 2000; 9: 486-495
• 34 Fry A et al. Prophylactic oophorectomy versus screening: psychosocial outcomes in women at increased risk of ovarian cancer. Psychooncology 2001; 10: 231-241
• 35 Antoniou A et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet 2003; 72: 1117-1130
• 36 Bonadona V et al. Cancer risks associated with germline mutations in MLH1, MSH2, and MSH6 genes in Lynch syndrome. JAMA 2011; 305: 2304-2310
• 37 Chen S et al. Characterization of BRCA1 and BRCA2 mutations in a large United States sample. J Clin Oncol 2006; 24: 863-871
• 38 Dreyer G. Screening for gynaecologic cancers in genetically predisposed women. Best Pract Res Clin Obstet Gynaecol 2012; 26: 267-282
• 39 Tinelli A et al. Hereditary ovarian cancers: from BRCA mutations to clinical management. A modern appraisal. Cancer Metastasis Rev 2010; 29: 339-350
• 40 Malamou-Mitsi V et al. Prognostic significance of HER-2, p 53 and Bcl-2 in patients with epithelial ovarian cancer. Anticancer Res 2007; 27: 1157-1165
• 41 Kommoss S et al. Independent prognostic significance of cell cycle regulator proteins p 16(INK4a) and pRb in advanced-stage ovarian carcinoma including optimally debulked patients: a translational research subprotocol of a randomised study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group. Br J Cancer 2007; 96: 306-313
• 42 Secord AA et al. Co-expression of angiogenic markers and associations with prognosis in advanced epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 2007; 106: 221-232
• 43 Bellati F et al. Immunology of gynecologic neoplasms: analysis of the prognostic significance of the immune status. Curr Cancer Drug Targets 2009; 9: 541-565
• 44 Cree IA. Chemosensitivity and chemoresistance testing in ovarian cancer. Curr Opin Obstet Gynecol 2009; 21: 39-43
• 45 Harry VN, Gilbert FJ, Parkin DE. Predicting the response of advanced cervical and ovarian tumors to therapy. Obstet Gynecol Surv 2009; 64: 548-560
• 46 Itamochi H, Kigawa J, Terakawa N. Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma. Cancer Sci 2008; 99: 653-658
• 47 Liu N, Wang X, Sheng X. ‘Triple negative epithelial ovarian cancer and pathologic markers for prognosis. Curr Opin Obstet Gynecol 2011; 23: 19-23
• 48 Sabatier R et al. Gene expression profiling and prediction of clinical outcome in ovarian cancer. Crit Rev Oncol Hematol 2009; 72: 98-109
• 49 Tian C et al. CA-125 change after chemotherapy in prediction of treatment outcome among advanced mucinous and clear cell epithelial ovarian cancers: a Gynecologic Oncology Group study. Cancer 2009; 115: 1395-1403
• 50 Trainer AH et al. Moving toward personalized medicine: treatment-focused genetic testing of women newly diagnosed with ovarian cancer. Int J Gynecol Cancer 2010; 20: 704-716
• 51 Shaw MC et al. Development of an evidence-based algorithm for the management of ovarian cancer. Eur J Gynaecol Oncol 2003; 24: 117-125
• 52 Ayhan A et al. Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer. Eur J Gynaecol Oncol 2003; 24: 223-232
• 53 Gershenson DM. Fertility-sparing surgery for malignancies in women. J Natl Cancer Inst Monogr 2005; 34: 43-47
• 54 Morice P et al. Conservative treatment in epithelial ovarian cancer: results of a multicentre study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer) and SFOG (Societe Francaise dʼOncologie Gynecologique). Hum Reprod 2005; 20: 1379-1385
• 55 Leitao Jr. MM, Chi DS. Fertility-sparing options for patients with gynecologic malignancies. Oncologist 2005; 10: 613-622
• 56 Dexeus S, Labastida R, Dexeus D. Conservative management of epithelial ovarian cancer. Eur J Gynaecol Oncol 2005; 26: 473-478
• 57 Monk BJ, Disaia PJ. What is the role of conservative primary surgical management of epithelial ovarian cancer: the United States experience and debate. Int J Gynecol Cancer 2005; 15 (Suppl. 03) 199-205
• 58 Colombo N et al. Role of conservative surgery in ovarian cancer: the European experience. Int J Gynecol Cancer 2005; 15 (Suppl. 03) 206-211
• 59 Marhhom E, Cohen I. Fertility preservation options for women with malignancies. Obstet Gynecol Surv 2007; 62: 58-72
• 60 Denschlag D et al. Clinical recommendation on fertility preservation in borderline ovarian neoplasm: ovarian stimulation and oocyte retrieval after conservative surgery. Gynecol Obstet Invest 2010; 70: 160-165
• 61 Sarnacki S, Brisse H. Surgery of ovarian tumors in children. Horm Res Paediatr 2011; 75: 220-224
• 62 Zanetta G et al. Conservative surgery for stage I ovarian carcinoma in women of childbearing age. Br J Obstet Gynaecol 1997; 104: 1030-1035
• 63 Schilder JM et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol 2002; 87: 1-7
• 64 Morice P et al. Results of conservative management of epithelial malignant and borderline ovarian tumours. Hum Reprod Update 2003; 9: 185-192
• 65 Duska LR et al. Epithelial ovarian carcinoma in the reproductive age group. Cancer 1999; 85: 2623-2629
• 66 Medeiros LR et al. Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer. Cochrane Database Syst Rev 2008; (4) CD005344
• 67 Trope C, Kaern J. Adjuvant chemotherapy for early-stage ovarian cancer: review of the literature. J Clin Oncol 2007; 25: 2909-2920
• 68 Panici PB et al. Laparoscopy compared with laparoscopically guided minilaparotomy for large adnexal masses: a randomized controlled trial. Obstet Gynecol 2007; 110 (2 Pt 1) 241-248
• 69 Ghezzi F et al. Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses. BJOG 2008; 115: 1020-1027
• 70 Fagotti A et al. Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery?. Gynecol Oncol 2010; 116: 72-77
• 71 Kindermann G, Maassen V, Kuhn W. Laparoscopic management of ovarian tumors subsequently diagnosed as malignant: a survey from 127 German departments of obstetrics and gynecology. J Pelvic Surgery 1996; 2: 245-251
• 72 Canis M et al. Laparoscopic management of adnexal masses: a gold standard?. Curr Opin Obstet Gynecol 2002; 14: 423-428
• 73 Randall TC, Rubin SC. Surgical management of ovarian cancer. Semin Surg Oncol 1999; 17: 173-180
• 74 Axtell AE et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol 2007; 25: 384-389
• 75 Wimberger P et al. Influence of residual tumor on outcome in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Ann Surg Oncol 2010; 17: 1642-1648
• 76 Gadducci A et al. Relationship between time interval from primary surgery to the start of taxane- plus platinum-based chemotherapy and clinical outcome of patients with advanced epithelial ovarian cancer: results of a multicenter retrospective Italian study. J Clin Oncol 2005; 23: 751-758
• 77 Trope C, Kaern J. Primary surgery for ovarian cancer. Eur J Surg Oncol 2006; 32: 844-852
• 78 Bristow RE et al. Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction. Gynecol Oncol 2007; 104: 480-490
• 79 Wimberger P et al. Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival. An exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 2007; 106: 69-74
• 80 Vernooij F et al. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol 2007; 105: 801-812
• 81 Elit LM et al. Surgical outcomes in women with ovarian cancer. Can J Surg 2008; 51: 346-354
• 82 Gerestein CG et al. The prediction of progression-free and overall survival in women with an advanced stage of epithelial ovarian carcinoma. BJOG 2009; 116: 372-380
• 83 du Bois A et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe dʼInvestigateurs Nationaux Pour les Etudes des Cancers de lʼOvaire (GINECO). Cancer 2009; 115: 1234-1244
• 84 Gerestein CG et al. Causes of postoperative mortality after surgery for ovarian cancer. Eur J Cancer 2009; 45: 2799-2803
• 85 Einenkel J et al. Characteristics and management of diaphragm involvement in patients with primary advanced-stage ovarian, fallopian tube, or peritoneal cancer. Int J Gynecol Cancer 2009; 19: 1288-1297
• 86 Tixier H et al. Evaluation of pelvic posterior exenteration in the management of advanced-stage ovarian cancer. Arch Gynecol Obstet 2010; 281: 505-510
• 87 Gerestein CG et al. Prediction of residual disease after primary cytoreductive surgery for advanced-stage ovarian cancer: accuracy of clinical judgment. Int J Gynecol Cancer 2009; 19: 1511-1515
• 88 Aletti GD et al. Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol 2011; 120: 23-28
• 89 du Bois A et al. Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: a systematic review. Gynecol Oncol 2009; 112: 422-436
• 90 Vergote I et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010; 363: 943-953
• 91 Schwartz PE et al. Neoadjuvant chemotherapy for advanced ovarian cancer: long-term survival. Gynecol Oncol 1999; 72: 93-99
• 92 van der Burg ME et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 1995; 332: 629-634
• 93 Rose PG et al. Gynecologic Oncology Group. Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 2004; 351: 2489-2497
• 94 Redman CW et al. Intervention debulking surgery in advanced epithelial ovarian cancer. Br J Obstet Gynaecol 1994; 101: 142-146
• 95 Tangjitgamol S et al. Interval debulking surgery for advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2010; (10) CD006014
• 96 Winter-Roach BA, Kitchener HC, Dickinson HO. Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer. Cochrane Database Syst Rev 2009; (3) CD004706
• 97 Young RC et al. Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials. N Engl J Med 1990; 322: 1021-1027
• 98 Trope C et al. Are borderline tumors of the ovary overtreated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors. Gynecol Oncol 1993; 51: 236-243
• 99 Trimbos JB et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Natl Cancer Inst 2003; 95: 113-125
• 100 Timmers PJ et al. Clear cell carcinoma compared to serous carcinoma in early ovarian cancer: same prognosis in a large randomized trial. Int J Gynecol Cancer 2009; 19: 88-93
• 101 Trimbos B et al. Surgical staging and treatment of early ovarian cancer: long-term analysis from a randomized trial. J Natl Cancer Inst 2010; 102: 982-987
• 102 Adams G et al. Platinum-based adjuvant chemotherapy for early-stage epithelial ovarian cancer: single or combination chemotherapy?. BJOG 2010; 117: 1459-1467
• 103 Takano M et al. Less impact of adjuvant chemotherapy for stage I clear cell carcinoma of the ovary: a retrospective Japan Clear Cell Carcinoma Study. Int J Gynecol Cancer 2010; 20: 1506-1510
• 104 Garcia-Saenz JA et al. Platinum-based adjuvant chemotherapy on moderate- and high-risk stage I and II epithelian ovarian cancer patients. Long-term single institution experience and literature review. Clin Transl Oncol 2011; 13: 121-132
• 105 Trimbos JB et al. International Collaborative Ovarian Neoplasm trial 1 and Adjuvant ChemoTherapy In Ovarian Neoplasm trial: two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. J Natl Cancer Inst 2003; 95: 105-112
• 106 Colombo N et al. International Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. J Natl Cancer Inst 2003; 95: 125-132
• 107 Vergote I et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 2001; 357: 176-182
• 108 Ho CM et al. Evaluation of complete surgical staging with pelvic and para-aortic lymphadenectomy and paclitaxel plus carboplatin chemotherapy for improvement of survival in stage I ovarian clear cell carcinoma. Gynecol Oncol 2003; 88: 394-399
• 109 Kitchener HC. Adjuvant chemotherapy improves survival after resection of stage 1 ovarian cancer. Cancer Treat Rev 2005; 31: 323-327
• 110 Shimada M et al. Outcome of patients with early ovarian cancer undergoing three courses of adjuvant chemotherapy following complete surgical staging. Int J Gynecol Cancer 2005; 15: 601-605
• 111 Bell J et al. Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2006; 102: 432-439
• 112 Obermair A et al. A new prognostic model for FIGO stage 1 epithelial ovarian cancer. Gynecol Oncol 2007; 104: 607-611
• 113 Skirnisdottir I, Sorbe B. Survival and prognostic factors in early-stage epithelial ovarian carcinoma treated with taxane-based adjuvant chemotherapy. Int J Gynecol Cancer 2007; 17: 1231-1237
• 114 Chan JK et al. Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study. Cancer 2008; 112: 2202-2210
• 115 Takano M et al. Clear cell carcinoma of the ovary: a retrospective multicentre experience of 254 patients with complete surgical staging. Br J Cancer 2006; 94: 1369-1374
• 116 Chan JK et al. The potential benefit of 6 vs. 3 cycles of chemotherapy in subsets of women with early-stage high-risk epithelial ovarian cancer: an exploratory analysis of a Gynecologic Oncology Group study. Gynecol Oncol 2010; 116: 301-306
• 117 Mannel RS et al. A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 2011; 122: 89-94
• 118 NICE. NICE clinical guideline 122. The recognition and initial management of ovarian cancer. 2011 [cited 2012 September 7]. http://guidance.nice.org.uk/CG122 Stand: 07.09.2012
• 119 NHS National Institute for Health and Clinical Excellence. Technology Appraisal Guidance 91 Paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan for second-line or subsequent treatment of advanced ovarian cancer. 2005 [cited 2012 September 7]. http://www.nice.org.uk/TA091 Stand: 07.09.2012
• 120 ICON Collaborators. ICON2: randomised trial of single-agent carboplatin against three-drug combination of CAP (cyclophosphamide, doxorubicin, and cisplatin) in women with ovarian cancer. ICON Collaborators. International Collaborative Ovarian Neoplasm Study. Lancet 1998; 352: 1571-1576
• 121 ICON Collaborators. Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet 2002; 360: 505-515
• 122 McGuire WP et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996; 334: 1-6
• 123 Muggia FM et al. Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a gynecologic oncology group study. J Clin Oncol 2000; 18: 106-115
• 124 Neijt JP et al. Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. J Clin Oncol 2000; 18: 3084-3092
• 125 Piccart MJ et al. Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. J Natl Cancer Inst 2000; 92: 699-708
• 126 West RJ, Zweig SF. Meta-analysis of chemotherapy regimens for ovarian carcinoma: a reassessment of cisplatin, cyclophosphamide and doxorubicin versus cisplatin and cyclophosphamide. Eur J Gynaecol Oncol 1997; 18: 343-348
• 127 Ozols RF. Chemotherapy for ovarian cancer. Semin Oncol 1999; 26 (6 Suppl. 18) 34-40
• 128 du Bois A, Neijt JP, Thigpen JT. First line chemotherapy with carboplatin plus paclitaxel in advanced ovarian cancer – a new standard of care?. Ann Oncol 1999; 10 (Suppl. 01) 35-41
• 129 Aabo K et al. Chemotherapy in advanced ovarian cancer: four systematic meta-analyses of individual patient data from 37 randomized trials. Advanced Ovarian Cancer Trialistsʼ Group. Br J Cancer 1998; 78: 1479-1487
• 130 du Bois A et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 2003; 95: 1320-1329
• 131 Ozols RF et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003; 21: 3194-3200
• 132 Burger RA et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 2011; 365: 2473-2483
• 133 Perren TJ et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 2011; 365: 2484-2496
• 134 McGuire 3rd WP. High-dose chemotherapeutic approaches to ovarian cancer management. Semin Oncol 2000; 27(3 Suppl. 7): 41-46
• 135 Mobus V et al. Phase III trial of high-dose sequential chemotherapy with peripheral blood stem cell support compared with standard dose chemotherapy for first-line treatment of advanced ovarian cancer: intergroup trial of the AGO-Ovar/AIO and EBMT. J Clin Oncol 2007; 25: 4187-4193
• 136 Katsumata N et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet 2009; 374: 1331-1338
• 137 Hoskins P et al. Advanced ovarian cancer: phase III randomized study of sequential cisplatin-topotecan and carboplatin-paclitaxel vs. carboplatin-paclitaxel. J Natl Cancer Inst 2010; 102: 1547-1556
• 138 Jaaback K, Johnson N. Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer. Cochrane Database Syst Rev 2006; (1) CD005340
• 139 Buyse M et al. Using the expected survival to explain differences between the results of randomized trials: a case in advanced ovarian cancer. J Clin Oncol 2003; 21: 1682-1687
• 140 Aravantinos G et al. Paclitaxel plus carboplatin versus paclitaxel plus alternating carboplatin and cisplatin for initial treatment of advanced ovarian cancer: long-term efficacy results: a Hellenic Cooperative Oncology Group (HeCOG) study. Ann Oncol 2005; 16: 1116-1122
• 141 Dizon DS et al. Two for good measure: six versus eight cycles of carboplatin and paclitaxel as adjuvant treatment for epithelial ovarian cancer. Gynecol Oncol 2006; 100: 417-421
• 142 Armstrong DK et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006; 354: 34-43
• 143 Grenman S et al. A randomised phase III study comparing high-dose chemotherapy to conventionally dosed chemotherapy for stage III ovarian cancer: the Finnish Ovarian Cancer (FINOVA) study. Eur J Cancer 2006; 42: 2196-2199
• 144 Spriggs DR et al. Phase III randomized trial of intravenous cisplatin plus a 24- or 96-hour infusion of paclitaxel in epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2007; 25: 4466-4471
• 145 Lhomme C et al. Phase III study of valspodar (PSC833) combined with paclitaxel and carboplatin compared with paclitaxel and carboplatin alone in patients with stage IV or suboptimally debulked stage III epithelial ovarian cancer or primary peritoneal cancer. J Clin Oncol 2008; 26: 2674-2682
• 146 Safra T et al. Combined weekly carboplatin and paclitaxel as primary treatment of advanced epithelial ovarian carcinoma. Gynecol Oncol 2009; 114: 215-218
• 147 Lambert HE et al. A randomized trial of five versus eight courses of cisplatin or carboplatin in advanced epithelial ovarian carcinoma. A North Thames Ovary Group Study. Ann Oncol 1997; 8: 327-333
• 148 Sorbe B. Swedish-Norgewian Ovarian Cancer Study Group. Consolidation treatment of advanced (FIGO stage III) ovarian carcinoma in complete surgical remission after induction chemotherapy: a randomized, controlled, clinical trial comparing whole abdominal radiotherapy, chemotherapy, and no further treatment. Int J Gynecol Cancer 2003; 13: 278-286
• 149 Mei L et al. Maintenance chemotherapy for ovarian cancer. Cochrane Database Syst Rev 2010; (9) CD007414
• 150 Berek J et al. Oregovomab maintenance monoimmunotherapy does not improve outcomes in advanced ovarian cancer. J Clin Oncol 2009; 27: 418-425
• 151 Pecorelli S et al. Phase III trial of observation versus six courses of paclitaxel in patients with advanced epithelial ovarian cancer in complete response after six courses of paclitaxel/platinum-based chemotherapy: final results of the After-6 protocol 1. J Clin Oncol 2009; 27: 4642-4648
• 152 Penson RT et al. Phase II study of carboplatin, paclitaxel, and bevacizumab with maintenance bevacizumab as first-line chemotherapy for advanced mullerian tumors. J Clin Oncol 2010; 28: 154-159
• 153 Pomel C et al. Hyperthermic intra-peritoneal chemotherapy using oxaliplatin as consolidation therapy for advanced epithelial ovarian carcinoma. Results of a phase II prospective multicentre trial. CHIPOVAC study. Eur J Surg Oncol 2010; 36: 589-593
• 154 Hess LM et al. Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer: a meta-analysis. Cancer 2010; 116: 5251-5260
• 155 Williams C, Simera I, Bryant A. Tamoxifen for relapse of ovarian cancer. Cochrane Database Syst Rev 2010; (3) CD001034
• 156 ten Bokkel Huinink W et al. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol 1997; 15: 2183-2193
• 157 Parmar MK et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 2003; 361: 2099-2106
• 158 Gordon AN et al. Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol 2001; 19: 3312-3322
• 159 Cantu MG et al. Randomized controlled trial of single-agent paclitaxel versus cyclophosphamide, doxorubicin, and cisplatin in patients with recurrent ovarian cancer who responded to first-line platinum-based regimens. J Clin Oncol 2002; 20: 1232-1237
• 160 Blackledge G et al. Response of patients in phase II studies of chemotherapy in ovarian cancer: implications for patient treatment and the design of phase II trials. Br J Cancer 1989; 59: 650-653
• 161 Eisenhauer EA et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
• 162 Rustin GJ et al. Definitions for response and progression in ovarian cancer clinical trials incorporating RECIST 1.1 and CA 125 agreed by the Gynecological Cancer Intergroup (GCIG). Int J Gynecol Cancer 2011; 21: 419-423
• 163 Friedlander M et al. Gynecologic Cancer InterGroup. Clinical trials in recurrent ovarian cancer. Int J Gynecol Cancer 2011; 21: 771-775
• 164 Meier W et al. Topotecan versus treosulfan, an alkylating agent, in patients with epithelial ovarian cancer and relapse within 12 months following 1st-line platinum/paclitaxel chemotherapy. A prospectively randomized phase III trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 2009; 114: 199-205
• 165 ten Bokkel Huinink W, Lane SR, Ross GA. Long-term survival in a phase III, randomised study of topotecan versus paclitaxel in advanced epithelial ovarian carcinoma. Ann Oncol 2004; 15: 100-103
• 166 Vergote I et al. Phase 3 randomised study of canfosfamide (Telcyta, TLK286) versus pegylated liposomal doxorubicin or topotecan as third-line therapy in patients with platinum-refractory or -resistant ovarian cancer. 2009. (1879-0852 [Electronic])
• 167 Ferrandina G et al. Phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in progressive or recurrent ovarian cancer. J Clin Oncol 2008; 26: 890-896
• 168 Mutch DG et al. Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol 2007; 25: 2811-2818
• 169 du Bois A et al. Chemotherapy versus hormonal treatment in platinum- and paclitaxel-refractory ovarian cancer: a randomised trial of the German Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) Study Group Ovarian Cancer. Ann Oncol 2002; 13: 251-257
• 170 Sehouli J et al. Nonplatinum topotecan combinations versus topotecan alone for recurrent ovarian cancer: results of a phase III study of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group. J Clin Oncol 2008; 26: 3176-3182
• 171 Peng LH, Chen XY, Wu TX. Topotecan for ovarian cancer. Cochrane Database Syst Rev 2008; (2) CD005589 DOI: 10.1002/14651858.CD005589.pub2.
• 172 Eisenkop SM, Friedman RL, Spirtos NM. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 2000; 88: 144-153
• 173 Harter P et al. Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee; AGO Ovarian Cancer Study Group. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 2006; 13: 1702-1710
• 174 Sehouli J et al. Role of secondary cytoreductive surgery in ovarian cancer relapse: who will benefit? A systematic analysis of 240 consecutive patients. J Surg Oncol 2010; 102: 656-662
• 175 Galaal K et al. Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev 2010; (6) CD007822
• 176 Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 2009; 112: 265-274
• 177 Harter P et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer 2011; 21: 289-295
• 178 Kew F et al. Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment. Cochrane Database Syst Rev 2011; (6) CD006119
• 179 Gadducci A et al. Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature. Int J Gynecol Cancer 2007; 17: 21-31
• 180 Guidozzi F, Daponte A. Estrogen replacement therapy for ovarian carcinoma survivors: A randomized controlled trial. Cancer 1999; 86: 1013-1018
• 181 Eeles RA et al. Hormone replacement therapy and survival after surgery for ovarian cancer. BMJ 1991; 302: 259-262
• 182 Ursic-Vrscaj M, Bebar S, Zakelj MP. Hormone replacement therapy after invasive ovarian serous cystadenocarcinoma treatment: the effect on survival. Menopause 2001; 8: 70-75
• 183 Mascarenhas C et al. Use of hormone replacement therapy before and after ovarian cancer diagnosis and ovarian cancer survival. Int J Cancer 2006; 119: 2907-2915
• 184 WHO. Classification of Tumours. Pathology and Genetics of Tumours of the Breast and female genital Organs. 3rd. ed. Switzerland: WHO-Press; 2003
• 185 Kaern J, Trope CG, Abeler VM. A retrospective study of 370 borderline tumors of the ovary treated at the Norwegian Radium Hospital from 1970 to 1982. A review of clinicopathologic features and treatment modalities. Cancer 1993; 71: 1810-1820
• 186 Leake JF et al. Long-term follow-up of serous ovarian tumors of low malignant potential. Gynecol Oncol 1992; 47: 150-158
• 187 Odegaard E et al. Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy. Acta Obstet Gynecol Scand 2007; 86: 620-626
• 188 Camatte S et al. Impact of surgical staging in patients with macroscopic “stage I” ovarian borderline tumours: analysis of a continuous series of 101 cases. Eur J Cancer 2004; 40: 1842-1849
• 189 Menczer J, Chetrit A, Sadetzki S. The effect of hysterectomy on survival of patients with borderline ovarian tumors. Gynecol Oncol 2012; 125: 372-375
• 190 du Bois A, Ewald-Riegler N. Borderline-Tumoren des Ovars – eine systematische Übersicht. Geburtsh Frauenheilk 2009; 69: 807-833
• 191 Morice P et al. Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer 2011; 21: 951-963
• 192 Faluyi O et al. Interventions for the treatment of borderline ovarian tumours. Cochrane Database Syst Rev 2010; (9) CD007696
• 193 Miller BE et al. Prognostic factors in adult granulosa cell tumor of the ovary. Cancer 1997; 79: 1951-1955
• 194 Nosov V et al. Predictors of recurrence of ovarian granulosa cell tumors. Int J Gynecol Cancer 2009; 19: 628-633
• 195 Colombo N et al. Management of ovarian stromal cell tumors. J Clin Oncol 2007; 25: 2944-2951
• 196 Sehouli J et al. Granulosa cell tumor of the ovary: 10 years follow-up data of 65 patients. Anticancer Res 2004; 24 (2C) 1223-1229
• 197 Zanagnolo V, Pasinetti B, Sartori E. Clinical review of 63 cases of sex cord stromal tumors. Eur J Gynaecol Oncol 2004; 25: 431-438
• 198 Evans 3rd AT et al. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Gynecol 1980; 55: 231-238
• 199 Zhang M et al. Prognostic factors responsible for survival in sex cord stromal tumors of the ovary – an analysis of 376 women. Gynecol Oncol 2007; 104: 396-400
• 200 Fotopoulou C et al. Adult granulosa cell tumors of the ovary: tumor dissemination pattern at primary and recurrent situation, surgical outcome. Gynecol Oncol 2010; 119: 285-290
• 201 Zambetti M et al. cis-platinum/vinblastine/bleomycin combination chemotherapy in advanced or recurrent granulosa cell tumors of the ovary. Gynecol Oncol 1990; 36: 317-320
• 202 Colombo N et al. Cisplatin, vinblastine, and bleomycin combination chemotherapy in metastatic granulosa cell tumor of the ovary. Obstet Gynecol 1986; 67: 265-268
• 203 Mahdi H et al. Prognostic impact of lymphadenectomy in clinically early stage malignant germ cell tumour of the ovary. Br J Cancer 2011; 105: 493-497
• 204 Gershenson DM. Management of ovarian germ cell tumors. J Clin Oncol 2007; 25: 2938-2943
• 205 Pectasides D, Pectasides E, Kassanos D. Germ cell tumors of the ovary. Cancer Treat Rev 2008; 34: 427-441
• 206 Kumar S et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of the ovary. Gynecol Oncol 2008; 110: 125-132
• 207 Oltmann SC et al. Pediatric ovarian malignancies: how efficacious are current staging practices?. J Pediatr Surg 2010; 45: 1096-1102
• 208 Gobel U et al. Treatment of germ cell tumors in children: results of European trials for testicular and non-testicular primary sites. Crit Rev Oncol Hematol 1990; 10: 89-98
• 209 Marina NM et al. Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: a Pediatric Oncology Group/Childrenʼs Cancer Group Intergroup Study. J Clin Oncol 1999; 17: 2137-2143
• 210 Gershenson DM et al. Second-look laparotomy in the management of malignant germ cell tumors of the ovary. Obstet Gynecol 1986; 67: 789-793
• 211 Billmire D et al. Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study. J Pediatr Surg 2004; 39: 424-429 discussion 424–429
• 212 Beiner ME et al. Cystectomy for immature teratoma of the ovary. Gynecol Oncol 2004; 93: 381-384
• 213 Cushing B et al. Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: a report of the Pediatric Oncology Group and the Childrenʼs Cancer Group. Am J Obstet Gynecol 1999; 181: 353-358
• 214 Kang H et al. Outcome and reproductive function after cumulative high-dose combination chemotherapy with bleomycin, etoposide and cisplatin (BEP) for patients with ovarian endodermal sinus tumor. Gynecol Oncol 2008; 111: 106-110
• 215 Chan JK et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol 2007; 109: 12-19
• 216 Kim HS et al. Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis. Int J Gynecol Cancer 2010; 20: 520-528
• 217 Maggioni A et al. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer 2006; 95: 699-704
• 218 Suzuki S et al. Is there any association between retroperitoneal lymphadenectomy and survival benefit in ovarian clear cell carcinoma patients?. Ann Oncol 2008; 19: 1284-1287
• 219 Yang X et al. Prognosis in epithelial ovarian cancer: clinical analysis of 287 pelvic and para-aortic lymphadenectomy. Chinese-German Journal of Clinical Oncology 2007; 6: 492-496
• 220 Yokoyama Y et al. Evaluation of cytoreductive surgery with pelvic and paraaortic lymphadenectomy and intermittent cisplatin-based combination chemotherapy for improvement of long-term survival in ovarian cancer. Eur J Gynaecol Oncol 1999; 20: 361-366
• 221 Young RC et al. Staging laparotomy in early ovarian cancer. JAMA 1983; 250: 3072-3076
• 222 Piver MS, Barlow JJ, Lele SB. Incidence of subclinical metastasis in stage I and II ovarian carcinoma. Obstet Gynecol 1978; 52: 100-104
• 223 Buchsbaum HJ et al. Surgical staging of carcinoma of the ovaries. Surg Gynecol Obstet 1989; 169: 226-232
• 224 Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975; 42: 101-104
• 225 Hoskins WJ et al. The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 1992; 47: 159-166
• 226 Hacker NF et al. Primary cytoreductive surgery for epithelial ovarian cancer. Obstet Gynecol 1983; 61: 413-420
• 227 Hunter RW, Alexander ND, Soutter WP. Meta-analysis of surgery in advanced ovarian carcinoma: is maximum cytoreductive surgery an independent determinant of prognosis?. Am J Obstet Gynecol 1992; 166: 504-511
• 228 Allen DG, Heintz AP, Touw FW. A meta-analysis of residual disease and survival in stage III and IV carcinoma of the ovary. Eur J Gynaecol Oncol 1995; 16: 349-356
• 229 Voest EE, van Houwelingen JC, Neijt JP. A meta-analysis of prognostic factors in advanced ovarian cancer with median survival and overall survival (measured with the log (relative risk] as main objectives. Eur J Cancer Clin Oncol 1989; 25: 711-720
• 230 Nguyen HN et al. National survey of ovarian carcinoma. Part V. The impact of physicianʼs specialty on patientsʼ survival. Cancer 1993; 72: 3663-3670
• 231 Junor EJ et al. Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients. Br J Obstet Gynaecol 1999; 106: 1130-1136
• 232 Bristow RE et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002; 20: 1248-1259
• 233 Elattar A et al. Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2011; (8) CD007565
• 234 Ang C et al. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev 2011; (4) CD007697
• 235 Bashir S et al. Surgical technique of diaphragm full-thickness resection and trans-diaphragmatic decompression of pneumothorax during cytoreductive surgery for ovarian cancer. Gynecol Oncol 2010; 119: 255-258
• 236 Sehouli J et al. Primary versus interval debulking surgery in advanced ovarian cancer: results from a systematic single-center analysis. Int J Gynecol Cancer 2010; 20: 1331-1340
• 237 Pfisterer J et al. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol 2006; 24: 4699-4707
• 238 Pujade-Lauraine E et al. Pegylated liposomal doxorubicin and carboplatin compared with paclitaxel and carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. J Clin Oncol 2010; 28: 3323-3329