Dr. Alejandra Martinez | Ovarian Cancer Surgical update 2025

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Join Alejandra Martinez from Toulouse University (IUCT Oncopole) as she presents the 2025 ovarian cancer surgical update, focusing on the timing of cytoreductive surgery, at the OncoAlert Colloquium 2026.

In this session, Dr. Martinez reviews the results of the TRUST and SUROVA trials and discusses how surgical timing impacts outcomes in advanced epithelial ovarian cancer.

Key topics covered:

1️⃣ Rationale for primary cytoreduction:

• Complete cytoreduction remains the strongest prognostic factor for PFS and OS.
• Guidelines recommend upfront surgery when complete resection is feasible with acceptable morbidity.
• Earlier phase III trials showed non-inferior survival for interval debulking surgery (IDS) but were criticized for low surgical quality and low complete resection rates.
• PARP inhibitor trials suggest best outcomes in patients achieving complete upfront cytoreduction.

2️⃣ TRUST trial (ASCO 2025):

• Phase III trial comparing primary cytoreduction vs neoadjuvant chemotherapy (NACT) + IDS.
• Conducted exclusively in ESGO-certified expert centers with strict surgical quality criteria.
• over 90% high-grade serous tumors; more 20% stage IV disease.
• Complete cytoreduction: 70% (primary) vs 85% (IDS).
• Median PFS: 22.1 vs 19.7 months; OS: 54.3 vs 48.3 months — no statistically significant difference.
• Subgroup analysis: survival benefit for primary surgery in stage III and completely resected patients.
• Higher morbidity in primary surgery group (18% vs 12%).

3️⃣ SUROVA trial (ESGO 2025):

• Real-world analysis including more than 3,000 patients across 55 countries.
• No overall PFS or OS difference according to surgical timing.
• Best outcomes observed in patients with complete cytoreduction and no postoperative complications.
• Emphasizes importance of surgical quality and morbidity control.

4️⃣ Practice implications (2025):

• Primary cytoreduction remains preferred in stage III disease when complete resection is achievable in expert centers.
• Surgical expertise and complication avoidance are critical determinants of outcome.
• Interval surgery remains appropriate when optimal upfront cytoreduction is unlikely.

5️⃣ What’s coming in 2026:

• Updated ESGO ovarian cancer guidelines.
• CHRONO trial results evaluating optimal timing of surgery after 3 vs 6 cycles of neoadjuvant chemotherapy.
Categoria
Oncology
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