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Ovarian Diseases HELP
Based on 39,210 articles published since 2010
|||| 32 

These are the 39210 published articles about Ovarian Diseases that originated from Worldwide during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: Recommendation Statement. 2020

Anonymous26511193. · ·Am Fam Physician · Pubmed #32053325.

ABSTRACT: -- No abstract --

2 Guideline O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. 2020

Andreotti, Rochelle F / Timmerman, Dirk / Strachowski, Lori M / Froyman, Wouter / Benacerraf, Beryl R / Bennett, Genevieve L / Bourne, Tom / Brown, Douglas L / Coleman, Beverly G / Frates, Mary C / Goldstein, Steven R / Hamper, Ulrike M / Horrow, Mindy M / Hernanz-Schulman, Marta / Reinhold, Caroline / Rose, Stephen L / Whitcomb, Brad P / Wolfman, Wendy L / Glanc, Phyllis. ·From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.) · Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.) · Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.) · Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.) · Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.) · Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.) · Department of Radiology, NYU Langone Health, New York, NY (G.L.B.) · Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.) · Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.) · Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.) · Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.) · Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.) · Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.) · Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.) · Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.) · Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.) · Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.) · Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.) · Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.) · and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.). ·Radiology · Pubmed #31687921.

ABSTRACT: The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is designed to provide consistent interpretations, to decrease or eliminate ambiguity in US reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. It was developed by an international multidisciplinary committee sponsored by the American College of Radiology and applies the standardized reporting tool for US based on the 2018 published lexicon of the O-RADS US working group. For risk stratification, the O-RADS US system recommends six categories (O-RADS 0-5), incorporating the range of normal to high risk of malignancy. This unique system represents a collaboration between the pattern-based approach commonly used in North America and the widely used, European-based, algorithmic-style International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa model system, a risk prediction model that has undergone successful prospective and external validation. The pattern approach relies on a subgroup of the most predictive descriptors in the lexicon based on a retrospective review of evidence prospectively obtained in the IOTA phase 1-3 prospective studies and other supporting studies that assist in differentiating management schemes in a variety of almost certainly benign lesions. With O-RADS US working group consensus, guidelines for management in the different risk categories are proposed. Both systems have been stratified to reach the same risk categories and management strategies regardless of which is initially used. At this time, O-RADS US is the only lexicon and classification system that encompasses all risk categories with their associated management schemes.

3 Guideline Recommendations for the implementation of BRCA testing in ovarian cancer patients and their relatives. 2019

Gori, Stefania / Barberis, Massimo / Bella, Maria Angela / Buttitta, Fiamma / Capoluongo, Ettore / Carrera, Paola / Colombo, Nicoletta / Cortesi, Laura / Genuardi, Maurizio / Gion, Massimo / Guarneri, Valentina / Incorvaia, Lorena / La Verde, Nicla / Lorusso, Domenica / Marchetti, Antonio / Marchetti, Paolo / Normanno, Nicola / Pasini, Barbara / Pensabene, Matilde / Pignata, Sandro / Radice, Paolo / Ricevuto, Enrico / Sapino, Anna / Tagliaferri, Pierosandro / Tassone, Pierfrancesco / Trevisiol, Chiara / Truini, Mauro / Varesco, Liliana / Russo, Antonio / Anonymous2720993. ·Oncology Department, IRCCS Sacro Cuore Don Calabria, Negrar, Verona, Italy. · Pathology Unit, European Institute of Oncology, Milan, Italy. · Medical Oncology Unit, University Hospital of Parma, Italy. · Center of Predictive Molecular Medicine, Center for Excellence on Aging and Translational Medicine, University of Chieti-Pescara, Italy. · Institute of Biochemistry & Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy. · Unit of Genomics for Diagnosis of Human Pathologies, Division of Genetics & Cell Biology, & Laboratory of Clinical Molecular Biology, IRCCS, Ospedale San Raffaele, Milan, Italy. · European Institute of Oncology 'IEO', Milan, Italy. · Department of Oncology, Hematology & Respiratory Diseases, University Hospital of Modena, Italy. · Institute of Genomic Medicine, 'A Gemelli' School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. · Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, Azienda ULSS3 Serenissima, Venice, Italy. · Department of Surgery, Oncology & Gastroenterology, University of Padova, Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy. · Department of Surgical, Oncological & Oral Sciences, Section of Medical Oncology, University of Palermo, Italy. · Department of Oncology, ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. · Università Cattolica del Sacro Cuore, Rome, Italy. · Center of Predictive Molecular Medicine, University-Foundation, CeSI Biotech Chieti, Italy. · Clinical & Molecular Medicine Department, Sapienza University, Rome, Italy. · Cell Biology & Biotherapy Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS Naples, Italy. · Department of Medical Science, University of Turin, Turin, Italy. · Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. · Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale", Naples, Italy. · Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. · Oncology Network ASL1 Abruzzo, Oncology Territorial Care Unit, Division of Medical Oncology, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, Italy. · Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy. · Department of Experimental & Clinical Medicine, Magna Graecia University, Salvatore Venuta University Campus, Catanzaro, Italy. · Translational Medical Oncology Unit, Department of Experimental and Clinical Medicine, Magna Græcia University and Cancer Center, Campus Salvatore Venuta, Catanzaro, Italy. · Veneto Institute of Oncology IOV - IRCCS, Padua, Italy. · Pathological Anatomy Histology & Cytogenetics, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milan, Italy. · Unit of Hereditary Cancers, IRCCS AOU San Martino - IST, Genoa, Italy. · Department of Surgical, Oncological & Oral Sciences, Section of Medical Oncology, University of Palermo, Italy. Electronic address: antonio.russo@usa.net. ·Crit Rev Oncol Hematol · Pubmed #31176273.

ABSTRACT: The current availability of new Poly(ADP-ribose) Polymerase (PARP)-inhibitors for the treatment of ovarian cancer patients independently of the presence of a BRCA pathogenic variant, together with the validation of somatic test for the analysis of BRCA1/2 genes, involves the need to optimise the guidelines for BRCA testing. The AIOM-SIGU-SIBIOC-SIAPEC-IAP Italian Scientific Societies, in this position paper, recommend the implementation of BRCA testing with 2 main objectives: the first is the identification of ovarian cancer patients with higher probability of benefit from specific anticancer treatments (test for response to therapy); the second goal, through BRCA testing in the family members of ovarian cancer patients, is the identification of carriers of pathogenic variant, who have inheredited predisposition to cancer development (test for cancer risk). These individuals with increased risk of cancer, should be encouraged to participate in dedicated high-risk surveillance clinics and specific risk-reducing measures (primary and/or secondary prevention programs).

4 Guideline Relapsed ovarian cancer - diagnosis using 18F-FDG PET/CT; 4. 2019

Esteves, Fabio Peroba / Amorim, Bárbara Juarez / Martello, Milena / Matushita, Cristina Sebastião / Gomes, Gustavo do Vale / Brito, Ana Emília T / Bernardo, Wanderley M. ·Brazilian Society of Nuclear Medicine, Rua Real Grandeza, 108 sala 101 - Botafogo, Rio de Janeiro - RJ, Brasil. · Brazilian Medical Association, Rua São Carlos do Pinhal, 324 - Bela Vista, São Paulo - SP, Brasil. ·Rev Assoc Med Bras (1992) · Pubmed #31066802.

ABSTRACT: The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize procedures to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

5 Guideline Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology. 2019

Lavoue, V / Huchon, C / Akladios, C / Alfonsi, P / Bakrin, N / Ballester, M / Bendifallah, S / Bolze, P A / Bonnet, F / Bourgin, C / Chabbert-Buffet, N / Collinet, P / Courbiere, B / De la Motte Rouge, T / Devouassoux-Shisheboran, M / Falandry, C / Ferron, G / Fournier, L / Gladieff, L / Golfier, F / Gouy, S / Guyon, F / Lambaudie, E / Leary, A / Lecuru, F / Lefrere-Belda, M A / Leblanc, E / Lemoine, A / Narducci, F / Ouldamer, L / Pautier, P / Planchamp, F / Pouget, N / Ray-Coquard, I / Rousset-Jablonski, C / Senechal-Davin, C / Touboul, C / Thomassin-Naggara, I / Uzan, C / You, B / Daraï, E. ·Service de gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France. Electronic address: Vincent.lavoue@chu-rennes.fr. · Service de Gynécologie, CHI Poissy, France. · Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France. · Service d'Anesthésie, Hôpital Saint Joseph, Paris, France. · Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service de gynécologie, GH Diaconesses Croix Saint Simon, Paris, France. · Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France. · Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France. · Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France. · Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France. · Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005 Marseille/Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397 Marseille, France. · Service d'oncologie médicale, Centre Eugène Marquis, Rennes, France. · Service d'anatomo-pathologie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service d'oncogériatrie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service d'oncologie chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France. · Service de radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service d'oncologie médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France. · Service de chirurgie, Institut Gustave Roussy, Villejuif, France. · Service de chirurgie, Institut Bergonié, Bordeaux, France. · Service de chirurgie, Institut Paoli Calmette, Marseille, France. · Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France. · Service de chirurgie gynécologique et oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service de chirurgie, Centre Oscar Lambret, Lille, France. · Service de chirurgie gynécologique, CHU de Tours, France. · Service de méthodologie, Institut Bergonié, Bordeaux, France. · Service de chirurgie, Curie (site Saint Cloud), Paris, France. · Service d'oncologie médicale, Centre Léon Bérard, Lyon, France. · Service de chirurgie gynécologique, CHI de Créteil, Créteil, France. · Service de radiologie, Hôpital Tenon, AP-HP, Paris, France. · Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France. · Service d'oncologie médicale, Institut de cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France. ·J Gynecol Obstet Hum Reprod · Pubmed #30936027.

ABSTRACT: An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).

6 Guideline Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2: systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up). 2019

Lavoue, V / Huchon, C / Akladios, C / Alfonsi, P / Bakrin, N / Ballester, M / Bendifallah, S / Bolze, P A / Bonnet, F / Bourgin, C / Chabbert-Buffet, N / Collinet, P / Courbiere, B / De la Motte Rouge, T / Devouassoux-Shisheboran, M / Falandry, C / Ferron, G / Fournier, L / Gladieff, L / Golfier, F / Gouy, S / Guyon, F / Lambaudie, E / Leary, A / Lecuru, F / Lefrere-Belda, M A / Leblanc, E / Lemoine, A / Narducci, F / Ouldamer, L / Pautier, P / Planchamp, F / Pouget, N / Ray-Coquard, I / Rousset-Jablonski, C / Senechal-Davin, C / Touboul, C / Thomassin-Naggara, I / Uzan, C / You, B / Daraï, E. ·Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France. Electronic address: Vincent.lavoue@chu-rennes.fr. · Service de Gynécologie, CHI Poissy, France. · Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France. · Service d'Anesthésie, Hôpital Saint Joseph, Paris, France. · Service de Chirurgie Digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service de Gynécologie, GH Diaconesses Croix Saint Simon, Paris, France. · Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France. · Service de Chirurgie Gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France. · Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France. · Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France. · Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005 Marseille/Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France. · Service d'oncologie Médicale, Centre Eugène Marquis, Rennes, France. · Service d'anatomo-pathologie, Hospices Civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service d'oncogériatrie, Hospices Civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service d'oncologie Chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France. · Service de Radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service d'oncologie Médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France. · Service de Chirurgie, Institut Gustave Roussy, Villejuif, France. · Service de Chirurgie, Institut Bergonié, Bordeaux, France. · Service de Chirurgie, Institut Paoli Calmette, Marseille, France. · Service d'oncologie Médicale, Institut Gustave Roussy, Villejuif, France. · Service de Chirurgie Gynécologique et Oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service de Chirurgie, Centre Oscar Lambret, Lille, France. · Service de Chirurgie Gynécologique, CHU de Tours, France. · Service de Méthodologie, Institut Bergonié, Bordeaux, France. · Service de Chirurgie, Curie (Site Saint Cloud), Paris, France. · Service d'oncologie Médicale, Centre Léon Bérard, Lyon, France. · Service de Chirurgie Gynécologique, CHI de Créteil, Créteil, France. · Service de Radiologie, Hôpital Tenon, AP-HP, Paris, France. · Service de Chirurgie et Cancérologie Gynécologique et Mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France. · Service d'oncologie Médicale, Institut de Cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France. ·J Gynecol Obstet Hum Reprod · Pubmed #30936025.

ABSTRACT: Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

7 Guideline Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Short text of the French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. 2019

Lavoue, V / Huchon, C / Akladios, C / Alfonsi, P / Bakrin, N / Ballester, M / Bendifallah, S / Bolze, P A / Bonnet, F / Bourgin, C / Chabbert-Buffet, N / Collinet, P / Courbiere, B / De la Motte Rouge, T / Devouassoux-Shisheboran, M / Falandry, C / Ferron, G / Fournier, L / Gladieff, L / Golfier, F / Gouy, S / Guyon, F / Lambaudie, E / Leary, A / Lecuru, F / Lefrere-Belda, M A / Leblanc, E / Lemoine, A / Narducci, F / Ouldamer, L / Pautier, P / Planchamp, F / Pouget, N / Ray-Coquard, I / Rousset-Jablonski, C / Senechal-Davin, C / Touboul, C / Thomassin-Naggara, I / Uzan, C / You, B / Daraï, E. ·Service de gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France. Electronic address: Vincent.lavoue@chu-rennes.fr. · Service de Gynécologie, CHI Poissy, France. · Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France. · Service d'Anesthésie, Hôpital Saint Joseph, Paris, France. · Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service de gynécologie, GH Diaconesses Croix Saint Simon, Paris, France. · Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France. · Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France. · Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France. · Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France. · Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005, Marseille, France; Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France. · Service d'oncologie médicale, Centre Eugène Marquis, Rennes, France. · Service d'anatomo-pathologie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service d'oncogériatrie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France. · Service d'oncologie chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France. · Service de radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service d'oncologie médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France. · Service de chirurgie, Institut Gustave Roussy, Villejuif, France. · Service de chirurgie, Institut Bergonié, Bordeaux, France. · Service de chirurgie, Institut Paoli Calmette, Marseille, France. · Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France. · Service de chirurgie gynécologique et oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. · Service de chirurgie, Centre Oscar Lambret, Lille, France. · Service de chirurgie gynécologique, CHU de Tours, France. · Service de méthodologie, Institut Bergonié, Bordeaux, France. · Service de chirurgie, Curie (site Saint Cloud), Paris, France. · Service d'oncologie médicale, Centre Léon Bérard, Lyon, France. · Service de chirurgie gynécologique, CHI de Créteil, Créteil, France. · Service de radiologie, Hôpital Tenon, AP-HP, Paris, France. · Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France. · Service d'oncologie médicale, Institut de cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #30905627.

ABSTRACT: An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (Grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (Grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). For FIGO stage III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (Grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancers (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III disease, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

8 Guideline [Management of tubo-ovarian abscesses and complicated pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. 2019

Graesslin, O / Verdon, R / Raimond, E / Koskas, M / Garbin, O. ·Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France. Electronic address: olivier.graesslin@gmail.com. · Service de maladies infectieuses et tropicales, CHRU de Caen, 14000 Caen, France. · Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France. · Service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris, France. · Service de gynécologie, CMCO, pôle de gynécologie des hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France. ·Gynecol Obstet Fertil Senol · Pubmed #30880246.

ABSTRACT: A tubo-ovarian abscess (ATO) should be suspected in a context of pelvic inflammatory disease (PID) in case of severe pain associated with the presence of general signs and palpation of an adnexal mass at pelvic examination. Imaging allows most often a rapid diagnosis, by ultrasound or CT, the latter being irradiant but also allowing to consider the differential diagnoses (digestive or urinary diseases) in case of pelvic pain. MRI, non-irradiating examination, whenever it is feasible, provides relevant information, more efficient, guiding quickly the diagnosis. The diagnosis of tubo-ovarian abscess should lead to the hospitalization of the patient, the collection of bacteriological samples, the initiation of a probabilistic antibiotherapy associated with drainage of the purulent collection. In severe septic forms (generalized peritonitis, septic shock), surgery (laparoscopy or laparotomy) keeps its place. In other situations, ultrasound-guided trans-vaginal puncture in the absence of major hemostasis disorders or severe sepsis is a less morbid alternative to surgery and provides high rates of cure. Today, ultrasound-guided trans-vaginal puncture has been satisfactory evaluated in the literature and is part of a logic of therapeutic de-escalation. Randomized trials evaluating laparoscopic drainage versus radiological drainage should be able to answer, in the coming years, questions that are still outstanding (impact on chronic pelvic pain, fertility). The recommendations for the management of ATO published in 2012 by the CNGOF remain valid, legitimizing the place of radiological drainage associated with antibiotic therapy.

9 Guideline [Management of epithelial ovarian cancer. Short text drafted from the French joint recommendations of FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa]. 2019

Lavoue, Vincent / Huchon, Cyrille / Akladios, Cherif / Alfonsi, Pascal / Bakrin, Naoual / Ballester, Marcos / Bendifallah, Sofiane / Bolze, Pierre-Adrien / Bonnet, Fabrice / Bourgin, Charlotte / Chabbert-Buffet, Nathalie / Collinet, Pierre / Courbiere, Blandine / De la Motte Rouge, Thibault / Devouassoux-Shisheboran, Mojgan / Falandry, Claire / Ferron, Gwenal / Fournier, Laure / Gladieff, Laurence / Golfier, François / Gouy, Sébastien / Guyon, Frédérique / Lambaudie, Eric / Leary, Alexandra / Lecuru, Fabrice / Lefrere-Belda, Marie-Aude / Leblanc, Eric / Lemoine, Adrien / Narducci, Fabrice / Ouldamer, Lobna / Pautier, Patricia / Planchamp, François / Pouget, Nicolas / Ray-Coquard, Isabelle / Rousset-Jablonski, Christine / Senechal-Davin, Claire / Touboul, Cyril / Thomassin-Naggara, Isabelle / Uzan, Catherine / You, Benoit / Daraï, Emile. ·CHU de Rennes, hôpital sud, service de gynécologie, 16, boulevard de Bulgarie, 35000 Rennes, France; Chemistry, oncogenesis, stress and signaling, centre Eugène Marquis, Inserm 1242, rue Bataille Flandres-Dunkerque, 35000 Rennes, France. Electronic address: Vincent.lavoue@chu-rennes.fr. · CHI Poissy, service de gynécologie, 78300 Poissy, France. · CHU Strasbourg, hôpital Hautepierre, service de gynécologie, 67000 Strasbourg, France. · Hôpital Saint-Joseph, service d'anesthésie, 75000 Paris, France. · CHU Lyon-Sud, service de chirurgie digestive, Pierre-Bénite, 69000 Lyon, France. · Groupe hospitalier Diaconesses Croix Saint Simon, service de gynécologie, 75000 Paris, France. · AP-HP, institut universitaire de cancérologie Sorbonne université, service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, UMRS-938, 4, rue de La Chine, 75020 Tenon, France. · CHU Lyon-Sud, service de chirurgie gynécologique, Pierre Bénite, 69000 Lyon, France. · AP-HP, hôpital Tenon, service d'anesthésie, 75020 Tenon, France. · CHRU, hôpital Jeanne de Flandres, service de chirurgie gynécologique, 59000 Lille, France. · AP-HM La Conception, pôle Femmes-Parents-Enfants-centre clinico-biologique d'AMP, 147, boulevard Baille, 13000 Marseille, France; Aix-Marseille université, CNRS, IRD, Avignon université, IMBE UMR 7263, 13000 Marseille, France. · Centre Eugène Marquis, service d'oncologie médicale, 35000 Rennes, France. · CHU Lyon-Sud, service d'anatomo-pathologie, hospices civiles de Lyon, Pierre-Bénite, 69000 Lyon, France. · CHU Lyon-Sud, service d'oncogériatrie, hospices civiles de Lyon, Pierre-Bénite, 69000 Lyon, France. · Institut Claudius Regaud, IUCT Oncopole, service d'oncologie chirurgicale, 31000 Toulouse, France. · AP-HP, service de radiologie, hôpital Européen Georges Pompidou, 75015 Paris, France. · Institut Claudius Regaud, IUCT Oncopole, service d'oncologie médicale, 31000 Toulouse, France. · Institut Gustave Roussy, service de chirurgie, 94800 Villejuif, France. · Institut Bergonié, service de chirurgie, 33000 Bordeaux, France. · Institut Paoli Calmette, service de chirurgie, 13000 Marseille, France. · Institut Gustave Roussy, service d'oncologie médicale, 94800 Villejuif, France. · AP-HP, hôpital Européen Georges Pompidou, service de chirurgie gynécologique et oncologique, 75015 Paris, France. · AP-HP, hôpital Européen Georges Pompidou, service d'anatomo-pathologie, 75015 Paris, France. · Centre Oscar Lambret, service de chirurgie, 59000 Lille, France. · CHU de Tours, service de chirurgie gynécologique, 37000 Tours, France. · Institut Bergonié, service de méthodologie, 33000 Bordeaux, France. · Curie (site Saint Cloud), service de chirurgie, 75000 Paris, France. · Centre Léon Bérard, service d'oncologie médicale, 69000 Lyon, France. · CHI de Créteil, service de chirurgie gynécologique, 94000 Créteil, France. · AP-HP, hôpital Tenon, service de radiologie, 75020 Tenon, France. · Institut universitaire de cancérologie, Sorbonne université, hôpital Pitié-Salpêtrière, service de chirurgie et cancérologie gynécologique et mammaire, Inserm U938, 75000 La pitié, France. · Institut de cancérologie des Hospices Civils de Lyon, service d'oncologie médicale, Pierre-Bénite, 69000 Lyon, France. ·Bull Cancer · Pubmed #30850152.

ABSTRACT: Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). In case of ovarian, Fallopian tube or primitive peritoneal cancer of FIGO III-IV stages, thoraco-abdomino-pelvic CT scan with injection (grade B) is recommended. Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A).

10 Guideline [Surgery for advanced stage ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Ferron, G / Narducci, F / Pouget, N / Touboul, C. ·Inserm CRCT 19, département de chirurgie oncologique, institut Claudius Regaud, institut universitaire du cancer, 31000 Toulouse, France. · Inserm U1192, département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France. · Département de chirurgie oncologique, chirurgie gynécologique et mammaire, institut Curie, site Saint-Cloud, 75005 Paris, France. · IMRB, U955 Inserm, service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Créteil, institut Mondor de recherche biomédicale, 94000 Créteil, France. Electronic address: Cyril.touboul@gmail.com. ·Gynecol Obstet Fertil Senol · Pubmed #30792175.

ABSTRACT: Debulking surgery is the key step of advanced stage ovarian cancer treatment with chemotherapy. The quality of surgical resection is the main prognosis factor, thus a complete resection must be achieved (grade A) in an expert center (grade B). Surgery for stage IV is possible and has a benefit in case of complete peritoneal resection (LoE3). Pelvic and aortic lymphadenectomies are recommended in case of clinical or radiological suspicious lymph nodes (grade B). In absence of clinical or radiological suspicious lymph nodes and in case of complete peritoneal resection during initial debulking surgery, lymphadenectomy can be omitted because it won't change nor medical treatment nor overall survival (grade B). Neoadjuvant chemotherapy can be proposed in case of: impossibility to perform initial complete surgical resection (grade B) ; alteration of general state or co-morbidities or elderly patient (in order to decrease morbidity and increase quality of life) (grade B); stage IV with multiple intra-hepatic or pulmonary metastasis or important ascites with miliary (grade B). In case of stage III or IV ovarian cancer diagnosed on a biopsy during prior laparotomy, a neoadjuvant chemotherapy and interval debulking surgery should be preferred (gradeC). In case of palliative surgery or peroperative impossibility to perform a complete resection, no data regarding the type of surgery to perform influencing survival or quality of life is available. Peritoneal carcinosis description before resection and residual disease at the end of the surgery should be reported (size, location and reason of non-extirpability) (grade B). A score of peritoneal carcinosis such as Peritoneal Carcinosis Index (PCI) should be used in order to objectively evaluate the tumoral burden (gradeC). A standardized operative report is recommended (gradeC).

11 Guideline British Menopause Society consensus statement on the management of estrogen deficiency symptoms, arthralgia and menopause diagnosis in women treated for early breast cancer. 2019

Marsden, Jo / Marsh, Mike / Rigg, Anne / Anonymous1180980. ·1 King's College Hospital, London, UK. · 2 Guy's and St Thomas' Hospital, London, UK. ·Post Reprod Health · Pubmed #30776968.

ABSTRACT: This guidance document by the British Menopause Society provides an overview of the management of women experiencing estrogen deficiency symptoms and arthralgia following a breast cancer diagnosis. It is now recommended that breast cancer patients are referred to health care professionals with an expertise in menopause for the management of such symptoms, which in turn often involves liaison with patients' breast cancer teams. However, as many women initially present to primary health care professionals for advice, this statement is aimed to support the latter in such consultations by providing information about symptom aetiology, current management strategies and controversies and identifying useful practice points.

12 Guideline [Diagnostic and prognostic value of tumor markers, scores (clinical and biological) algorithms, in front of an ovarian mass suspected of an epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Bendifallah, S / Body, G / Daraï, E / Ouldamer, L. ·Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, université de Sorbonne, 75000 Paris, France. · Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France. · Département de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Inserm UMR S 938, université Pierre-et-Marie-Curie, 75000 Paris, France. · Département de gynécologie, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm U1069, université François-Rabelais, 37044 Tours, France. Electronic address: l.ouldamer@chu-tours.fr. ·Gynecol Obstet Fertil Senol · Pubmed #30733191.

ABSTRACT: OBJECTIVES: To evaluate the diagnostic value of serum/urinary biomarkers and the operability diagnosis strategy to make management recommendations. METHODS: Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and Embase databases. RESULTS: For the diagnosis of a suspicious adnexal mass on imaging: Serum CA125 antigen is recommended (grade A). Serum CAE is not recommended (grade C). The low evidence in literature concerning diagnostic value of CA19.9 does not allow any recommendation concerning its use. Serum Human epididymis protein 4 (HE4) is recommended (grade A). Comparison of data concerning diagnosis value of CA125 and HE4 show similar results for the prediction of malignancy in case of a suspicious adnexal mass on imaging (NP1). Urinary HE4 is not recommended (grade A). The use of circulating tumor DNA is not recommended (grade A). Tumor associated antigen-antibodies (AAbs) is not recommended (grade B). The use of ROMA score (Risk of Ovarian Malignancy Algorithm) is recommended (grade A). The use of Copenhagen index (CPH-I), R-OPS score, OVA500 is not recommended (grade C). For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of a primary debulking surgery: It is not recommendend to use serum CA125 (grade A). The low evidence in literature concerning diagnostic value of HE4 does not allow any recommendation concerning its use in this context. No recommendation can be given concerning CA19.9 and CAE. For the prediction of resectability of an ovarian cancer with peritoneal carcinomatosis in the context of surgery after neoadjuvant chemotherapy: the low evidence in literature concerning diagnostic value of serum markers in this context does not allow any recommendation concerning their use in this context. Place of laparoscopy for the prediction of resectability in case of upfront surgery of an ovarian cancer with peritoneal carcinomatosis robust data shows that the use of laparoscopy significantly reduce futile laparotomies (LE1). Laparoscopy is recommended in this context (grade A). Fagotti score is a reproducible tool (LE1) permitting the evaluation of feasibility of an optimal upfront debulking (NP4), its use is recommended (grade C). A Fagotti score≥8 is correlated to a low probability of complete or optimal debulking surgery (LE4) (grade C). There is no sufficient evidence to recommend the use of the modified Fagotti score or any other laparoscopic score (LE4). In case of laparotomy for an ovarian cancer with peritoneal carcinomatosis, the use of Peritoneal Cancer Index (PCI) is recommended (grade C). For the prediction of overall survival, disease free survival and the prediction of postoperative complications, the clinical and statistical of actually available tools do not allow any recommendation.

13 Guideline [Epithelial ovarian cancer and elderly patients. Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Falandry, C / Gouy, S. ·Service de gériatrie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69000 Pierre-Bénite, France; Inserm U 1060, Inra U 1235, Insa, HCL, laboratoire de recherche CarMEN, université de Lyon 1, 64959 Oullins, France. Electronic address: claire.falandry@chu-lyon.fr. · Institut Gustave-Roussy, 94800 Villejuif, France. ·Gynecol Obstet Fertil Senol · Pubmed #30712964.

ABSTRACT: In ovarian, tubal and primary peritoneal cancers, older adults have an over-mortality due to more aggressive disease (NP4), surgical and chemotherapy under treatment (NP4) and co-morbidities (NP4). Older age is at higher risk for postoperative morbidity and mortality (NP4). Surgery is more often incomplete in this elderly population (NP4). Older age is a risk factor for lower dose intensity in adjuvant chemotherapy (NP4) and incomplete chemotherapy (NP4). Nevertheless, the benefit of a complete surgery remains identical to that of the younger population (NP2). Preoperative functional assessment identifies patients at risk for postoperative complications (NP4). The perioperative risk depends on three variables, the ASA score, the age and the complexity score of the surgery (NP4). It is recommended to perform cytoreduction surgery in an expert centre (grade C) and on the basis of geriatric expertise analysing functional and physical performance (grade C). The benefit/risk balance of surgery should be assessed on a case-by-case basis for the most at-risk (NP4) populations defined by: (i) age≥80 years, especially if albuminemia≤37g/L; (ii) age≥75 years and FIGO stage IV; (iii) age≥75 years, stage FIGO III and≥1 comorbidity. A comprehensive geriatric assessment is recommended prior to the management of an elderly person with primary ovarian, tubal or peritoneal cancer (grade C). The GVS (Geriatric Vulnerability Score) is used to identify vulnerable elderly patients (NP2). In fit elderly patients, it is recommended to perform intravenous chemotherapy identical to that of younger patients (ie platinum-based dual therapy) (grade B). In vulnerable elderly patients, various adapted chemotherapy regimens have been prospectively evaluated in non-comparative trials, and seem feasible considering specific and nonspecific toxicities: carboplatin monotherapy (NP2), carboplatin AUC2+paclitaxel 60mg/m

14 Guideline [Malignant epithelial ovarian cancer: Role of intra peritoneal chemotherapy and hyperthermic intra peritoneal chemotherapy (HIPEC): Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Bakrin, N / Gladieff, L. ·Service de chirurgie digestive et oncologique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre Bénite, France. Electronic address: naoual.bakrin@chu-lyon.fr. · Département d'oncologie médicale, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopole, 31000 Toulouse, France. ·Gynecol Obstet Fertil Senol · Pubmed #30712963.

ABSTRACT: Intraperitoneal drug delivery in first-line treatment of advanced ovarian cancer have been widely studied. After a complete primary surgery or with residual disease<1cm, intraperitoneal chemotherapy significantly improves disease-free and overall survival (NP1), but with more local and systemic toxicities. Whenever this therapeutic option is under consideration, the ratio efficacy/toxicity must be carefully discussed. Intraperitoneal chemotherapy has to be considered after complete or optimal primary surgery in ovarian, tubal or primitive peritoneal carcinomatosis FIGO IIIC. This treatment must be performed by trained teams and after an assessment of the ratio efficacy/toxicity. In one randomized study, hyperthermic intraperitoneal chemotherapy (HIPEC) using cisplatinum at interval surgery demonstrated an improvement in recurrence free and overall survival compared to surgery alone, in patients initially not resectable and with residual tumor less than 1cm (complete or optimal surgery) (NP1). HIPEC has to be considered after a complete or optimal interval surgery (residu<10mm) in patients with ovarian, tubal or primitive carcinomatosis FIGO IIIC, initially not resectable (Grade B).

15 Guideline [Medical treatment in ovarian cancers newly diagnosed: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

de la Motte Rouge, T / Ray-Coquard, I / You, B. ·Département d'oncologie médicale, centre Eugène-Marquis, avenue Bataille-Flandres-Dunkerques, 35042 Rennes, France. Electronic address: t.delamotterouge@rennes.unicancer.fr. · Département d'oncologie médicale, centre Léon-Bérard, 69000 Lyon, France. · CITOHL, service d'oncologie médicale, centre hospitalier Lyon Sud, institut de cancérologie des hospices civils de Lyon (IC-HCL), 69000 Lyon, France. ·Gynecol Obstet Fertil Senol · Pubmed #30709790.

ABSTRACT: Medical treatment of ovarian cancer is based on chemotherapy. Most patients, regardless of the initial stage of their disease, will need to be treated (grade A). Standard treatment relies on a carboplatin and paclitaxel combination (grade A). For advanced diseases (stage I-IIA1 or IIIB à IV), the addition of an antiangiogenic treatment with bevacizumab to the chemotherapy, followed by a maintenance for 15 months should be proposed as it allows better disease control (grade A). For patients with somatic or germline BRCA mutations and disease stage III or IV, olaparib is recommended as maintenance treatment for 24 months (grade B, but olaparib had not the French approval as first-line treatment at the time of the present recommendation editing). No other targeted therapy or immunotherapy has yet been proven effective at the initial phase of ovarian cancer treatment. The treatment of rare tumors with a special histology must be discussed in a specialized multidisciplinary meeting of the network of rare malignant tumors of the ovary (TMRO) labeled by the INCa.

16 Guideline [Epithelial ovarian cancer and fertility preservation: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Uzan, C / Courbiere, B / Chabbert-Buffet, N. ·Centre de Recherche Saint Antoine UMRS_938, service de chirurgie et cancérologie gynécologique et mammaire, institut universitaire de cancérologie, hôpital Pitié Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France. · Pôle Femmes-Parents-Enfants - Centre clinico-biologique d'AMP, Plateforme Cancer et Fertilité ONCOPACA-Corse/CECOS, AP-HM, Hôpital La Conception, 13005 Marseille, France; IMBE UMR 7263, 13397, Aix-Marseille université, CNRS, IRD, Avignon université, 13000 Marseille, France. · Centre de Recherche Saint Antoine UMRS_938, service de gynécologie, obstétrique, médecine de la reproduction, institut universitaire de cancérologie, Groupe Hospitalier AP-HP, 6 site Tenon, Sorbonne université, Plateforme de préservation de la fertilité, 4, rue de la Chine, 75020 Paris, France. Electronic address: nathalie.chabbert-buffet@aphp.fr. ·Gynecol Obstet Fertil Senol · Pubmed #30704956.

ABSTRACT: OBJECTIVES: To study the methods and strategies of fertility preservation in young women with stage I epithelial ovarian cancer (EOC), in order to provide recommendations for clinical practice. METHODS: The PubMed database was searched for english and french language articles, between 2005 and 2001, according to predefined search equations. RESULTS: Young patients with stage IA EOC willing to conceive should be informed that conservative treatment (contralateral ovary and salpinx, uterus) is possible (GradeC), associated with a 6 % to 13 % recurrence risk (GradeC) on the remaining ovary. This conservative surgical treatment includes adnexectomy, peritoneal and lymph node staging for all subtypes, and additional endometrial curettage for endometriosis and mucinous subtypes (GradeC). In case of positive staging conservative treatment is not possible. In case of mucinous EOC with an infiltrative pattern, lymph node staging is not necessary. Multidisciplinary analysis (including oncologists and reproductive medicine specialists) of the risk-benefit balance for a conservative surgery is recommended and must rely on a complete final pathology report (GradeC). No recommendation on bilateral adnexectomy and uterine conservation to allow pregnancy using egg donation can be provided in case of low-grade stage IA EOC, in the absence of data. Bilateral adnexectomy and uterine conservation to allow pregnancy using egg donation can be offered in case of serous, mucinous or endometrioid high-grade FIGO stage IA or low-grade FIGO stage IC1 or IC2 EOC (GradeC). Preservation of the uterus and contralateral ovary and Fallopian tube can be discussed with a specialized rare ovarian tumors multidiciplinary staff in case of clear cell stage I EOC.

17 Guideline [Part II drafted from the short text of the French guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Systemic and intraperitoneal treatment, elderly, fertility preservation, follow-up)]. 2019

Lavoué, V / Huchon, C / Akladios, C / Alfonsi, P / Bakrin, N / Ballester, M / Bendifallah, S / Bolze, P A / Bonnet, F / Bourgin, C / Chabbert-Buffet, N / Collinet, P / Courbiere, B / De la Motte Rouge, T / Devouassoux-Shisheboran, M / Falandry, C / Ferron, G / Fournier, L / Gladieff, L / Golfier, F / Gouy, S / Guyon, F / Lambaudie, E / Leary, A / Lécuru, F / Lefrère-Belda, M A / Leblanc, E / Lemoine, A / Narducci, F / Ouldamer, L / Pautier, P / Planchamp, F / Pouget, N / Ray-Coquard, I / Rousset-Jablonski, C / Sénéchal-Davin, C / Touboul, C / Thomassin-Naggara, I / Uzan, C / You, B / Daraï, E. ·Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, chemistry, oncogenesis, stress and signaling, centre Eugène-Marquis, rue Bataille-Flandres-Dunkerques, 35000 Rennes, France. Electronic address: Vincent.lavoue@chu-rennes.fr. · Service de gynécologie, CHI Poissy, 78000 Poissy, France. · Service de gynécologie, hôpital Hautepierre, CHU de Strasbourg, 67000 Strasbourg, France. · Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France. · Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service de gynécologie, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France. · Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France. · Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France. · Pôle Femmes-Parents-Enfants, centre clinico-biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, IRD, IMBE UMR 7263, Avignon université, Aix Marseille université, 13397 Marseille, France. · Service d'oncologie médicale, centre Eugène-Marquis, 35000 Rennes, France. · Service d'anatomo-pathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service d'oncologie chirurgicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France. · Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France. · Service d'oncologie médicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France. · Service de chirurgie, institut Gustave-Roussy, 94000 Villejuif, France. · Service de chirurgie, institut Bergonié, 33000 Bordeaux, France. · Service de chirurgie, institut Paoli-Calmette, 13000 Marseille, France. · Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France. · Service de chirurgie gynécologique et oncologique, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France. · Service d'anatomo-pathologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France. · Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France. · Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France. · Service de méthodologie, institut Bergonié, 33000 Bordeaux, France. · Service de chirurgie, Curie (site Saint-Cloud), 75000 Paris, France. · Service d'oncologie médicale, centre Léon-Bérard, 69000 Lyon, France. · Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France. · Service de radiologie, hôpital Tenon, AP-HP, 75020 Paris, France. · Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France. · Service d'oncologie médicale, institut de cancérologie, hospices civils de Lyon, Pierre-Bénite, 69000 Lyon, France. ·Gynecol Obstet Fertil Senol · Pubmed #30704955.

ABSTRACT: Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).

18 Guideline [Perioperative care of epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Lemoine, A / Lambaudie, E / Bonnet, F / Leblanc, E / Alfonsi, P. ·Service d'anesthésie, hôpital Tenon, médecine Sorbonne université, 75020 Paris, France. Electronic address: adrien.lemoine@aphp.fr. · Inserm, département de chirurgie oncologique, institut Paoli Calmettes, Aix-Marseille université, CNRS, 13000 Marseille, France. · Service d'anesthésie, hôpital Tenon, médecine Sorbonne université, 75020 Paris, France. · Département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France. · Service d'anesthésie, université Paris Descartes, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #30686730.

ABSTRACT: The following recommendations cover the perioperative management of ovarian, Fallopian tube and primary peritoneal cancers. Five questions related to pre-habilitation and enhanced recovery after surgery were evaluated. The conclusions and recommendations are based on an analysis of the level of evidence available in the literature. These recommendations are part of the overall recommendations for improving the management of ovarian, fallopian or primary peritoneal cancer, made with the support of INCa (Institut National du Cancer). The main preoperative measures are screening for nutritional deficiencies (Grade B) and for anaemia (GradeC) in patients with ovarian cancer. It is not possible to make recommendations on the correction of malnutrition and/or anemia or on the contribution of pre-operative immuno-nutrition due to the absence of data in ovarian cancer, tube cancer or primary peritoneum cancer. For the same reasons, no recommendation can be made on the value of preoperative digestive preparation in ovarian, fallopian tube or primary peritoneum cancer. During surgery, goal-directed fluid therapy for patients with advanced ovarian cancer is recommended (Grade B). A single dose infusion of tranexamic acid is recommended for patients with ovarian, fallopian tube or primary peritoneal cancer (GradeC). For postoperative analgesia, epidural analgesia is recommended for patients undergoing cyto-reduction surgery by laparotomy (Grade B). In the absence of epidural analgesia, patient controlled analgesia with morphine without continuous infusion (Grade B) is recommended. No recommendation can be given regarding intravenous administration of lidocaine and/or ketamine during surgery, or, regarding peri-operatively prescription of gabapentin or pregabalin. In the absence of studies on the impact of different non-opiate analgesic combinations for ovarian cancer surgery, no recommendations can be made. Early oral feeding is recommended, including in cases of digestive resection (Grade B). The implementation of enhanced recovery programs, including early mobilization, is recommended (GradeC).

19 Guideline [Diagnostic value of imaging (ultrasonography, doppler, CT, MR, PET-CT) for the diagnosis of a suspicious ovarian mass and staging of ovarian, tubal or primary peritoneal cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Thomassin-Naggara, I / Daraï, E / Lécuru, F / Fournier, L. ·Service de radiologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; Équipe medecine- Jussieu, institut des sciences du calcul et de données (ISCD), Sorbonne université 4, place Jussieu, 75006 Paris, France. Electronic address: isabelle.thomassin@tnn.aphp.fr. · Service de gynécologie et obstétrique, hôpital Tenon, Assistance publique-Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. · Service de radiologie, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes Sorbonne Paris Cité, Inserm UMR-S970, Cardiovascular Research Center - PARCC, 56, rue Leblanc, 75015 Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #30686729.

ABSTRACT: Transvaginal ultrasound is the first-line examination allowing characterizing 80 to 90% of adnexal masses (LP1). If performed by an expert, a subjective analysis is optimal. If performed by a non-expert, combining the use of Simple Rules with subjective analysis can achieve the diagnostic performance of an expert (LP1). Whichever the chosen model (subjective analysis by an expert or combination of the Simple Rules with a subjective analysis by a non-expert), a second-line examination will have to be proposed in the complex or indeterminate cases (about 20% of the masses) (grade A). The best-performing second-line test for characterization is pelvic MRI (LP1). If read by an expert, a pathological hypothesis can or should be suggested (grade D). In case of non-expert reading, the use of the ADNEXMR score allows a reliable assessment of the positive predictive value of malignancy to guide the patient towards the best management (gradeC). For preoperative assessment and evaluation of resectability of ovarian, fallopian tube or primary peritoneal cancer, it is recommended to perform a chest abdomen and pelvis CT with contrast agent injection (LP2, grade B). In the event of a contraindication to the injection of iodinated contrast agent (severe renal insufficiency, GFR <30mL/min), an abdomen and pelvis MRI completed with a non-injected chest CT may be proposed (LP3, grade C). By analogy, the same examinations are recommended to evaluate the disease after neo-adjuvant chemotherapy (LP3, Recommendation grade C). Further studies will be required to determine whether PET-CT provides better lymph node assessment before retroperitoneal and pelvic lymphadenectomy. PET-CT may be used to eliminate lymph node involvement in the absence of suspicious lymph nodes on morphological examination (LP3, grade C). The report should specify the localizations leading to a risk of incomplete cytoreductive surgery and lesions outside the field explored during surgery.

20 Guideline [Biopathology of ovarian carcinomas early and advanced-stages: Article drafted from the French guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Devouassoux-Shisheboran, M / Le Frère-Belda, M-A / Leary, A. ·Institut multisite de biopathologie des hôpitaux de Lyon : site Sud, centre de biologie et pathologie Sud, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France. Electronic address: Mojgan.devouassoux@chu-lyon.fr. · Service de pathologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France. · Inserm U981, service d'oncologie médicale, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France. ·Gynecol Obstet Fertil Senol · Pubmed #30686728.

ABSTRACT: OBJECTIVES: Ovarian carcinomas represent a heterogeneous group of lesions with specific therapeutic management for each histological subtype. Thus, the correct histological diagnosis is mandatory. MATERIAL AND METHODS: References were searched by PubMed from January 2000 to January 2018 and original articles in French and English literature were selected. RESULTS AND CONCLUSIONS: In case of ovarian mass suspicious for cancer, a frozen section analysis may be proposed, if it could impact the surgical management. A positive histological diagnosis of ovarian carcinoma (type and grade) has to be rendered on histological (and not cytological) material before any chemotherapy with multiples and large sized biopsies. In case of needle biopsy, at least three fragments with needles>16G are needed. Histological biopsies need to be formalin-fixed (4% formaldehyde) less than 1h after resection and at least 6hours fixation is mandatory for small size biopsies. Tissue transfer to pathological labs up to 48hours under vacuum and at +4°C (in case of large surgical specimens) may be an alternative. Gross examination should include the description of all specimens and their integrity, the site of the tumor and the dimension of all specimens and nodules. Multiples sampling is needed, including the capsule, the solid areas, at least 1 to 2 blocks per cm of tumor for mucinous lesions, the Fallopian tube in toto, at least 3 blocks on grossly normal omentum and one block on the largest omental nodule. WHO classification should be used to classify the carcinoma (type and grade), with the use of a panel of immunohistochemical markers. High-grade ovarian carcinomas (serous and endometrioid) should be tested for BRCA mutation and in case of a detectable tumor mutation, the patient should be referred to an oncogenetic consultation.

21 Guideline [Surgery in early-stage ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Bolze, P-A / Collinet, P / Golfier, F / Bourgin, C. ·Service de chirurgie gynécologique et oncologique, obstétrique, centre hospitalier universitaire Lyon Sud, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: pierre-adrien.bolze@chu-lyon.fr. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 1, rue Eugène-Avinée, 59000 Lille, France. · Service de chirurgie gynécologique et oncologique, obstétrique, centre hospitalier universitaire Lyon Sud, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. ·Gynecol Obstet Fertil Senol · Pubmed #30686727.

ABSTRACT: Early stage ovarian epithelial cancer (stage I according to the FIGO classification, i.e. limited to ovaries) affects 20% to 33% of patients with ovarian cancer. This chapter only describes data on these presumed early stages. The rate of occult epiploic metastases varies from 2% to 4%, and leads to over-staging in stage III A of 3% to 11% of patients. Performing an omentectomy does not result in a change in survival in this situation (NP4). The rate of appendix metastasis ranges from 0% to 26.7% (NP4). In the mucinous subtype, this rate can reach 53% if the appendix is macroscopically abnormal (NP2). The rate of positive peritoneal cytology ranges from 20.9% to 27%. Positive peritoneal cytology is responsible for over-staging of patients in 4.3% to 52% of cases and appears as a poor prognostic factor on survival (NP4). The rate of occult peritoneal metastases varies from 1.1% to 16%. Performing these peritoneal biopsies results in over-staging of 4% to 7.1% (NP4). In the management of ovarian cancers at a presumed early stage, it is recommended to perform: omentectomy, peritoneal biopsies, cytology, appendectomy (grade C). In case of incomplete or incomplete initial staging, restaging including omentectomy, peritoneal biopsies and appendectomy (if not explored) is recommended; especially in the absence of a reported indication of chemotherapy. The lymph node invasion rate ranges from 6.3% to 22%. It is 4.5% to 18% for stages I and 17.5% to 31% in stages II. Between 8.5% and 13% of patients with suspected early stage ovarian cancer are reclassified to stage IIIA1 following the completion of lymphadenectomy (NP3). Pelvic and lumbo-aortic lymphadenectomy improves the survival of patients with ovarian cancer at a presumptive early stage (NP2). Pelvic and lumbo-aortic lymphadenectomy is recommended for presumed early ovarian stages (grade B). In case of initial treatment of early-stage ovarian cancer without lymph node staging, restadification including lymphadenectomy is recommended; especially in the absence of a stated indication of chemotherapy (grade B). No studies have shown any laparoscopic disadvantage compared to laparotomy for feasibility, safety, or postoperative rehabilitation (NP3) in surgical staging of patients with early-stage ovarian cancer. For the initial surgical management of these patients, the choice between laparoscopy or laparotomy depends on local conditions (tumor size) and surgical expertise. If complete surgery without risk of tumor rupture is possible, the laparoscopic approach is preferred (grade C). In the opposite case, median laparotomy is recommended. As part of surgical restadification, the laparoscopic approach is recommended (grade C). Intraoperative tumor rupture leads to a decrease in disease free survival (hazard ratio=2.28) and overall survival (hazard ratio=3.79) (NP2). It is recommended that all precautions be taken to avoid perioperative ovarian tumor rupture, including the intraoperative decision of laparoconversion (grade C). There is no specific study to answer the question of the feasibility of a one-time or two-time surgery during an extemporane diagnosis of an early stage ovarian cancer. The high sensitivity and specificity of this extemporane examination in this situation makes it possible to consider a surgical management of staging during the same operating time.

22 Guideline [Part I drafted from the short text of the French Guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Diagnosis management, surgery, perioperative care, and pathological analysis)]. 2019

Lavoué, V / Huchon, C / Akladios, C / Alfonsi, P / Bakrin, N / Ballester, M / Bendifallah, S / Bolze, P A / Bonnet, F / Bourgin, C / Chabbert-Buffet, N / Collinet, P / Courbiere, B / De la Motte Rouge, T / Devouassoux-Shisheboran, M / Falandry, C / Ferron, G / Fournier, L / Gladieff, L / Golfier, F / Gouy, S / Guyon, F / Lambaudie, E / Leary, A / Lécuru, F / Lefrère-Belda, M A / Leblanc, E / Lemoine, A / Narducci, F / Ouldamer, L / Pautier, P / Planchamp, F / Pouget, N / Ray-Coquard, I / Rousset-Jablonski, C / Sénéchal-Davin, C / Touboul, C / Thomassin-Naggara, I / Uzan, C / You, B / Daraï, E. ·Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, rue Bataille Flandres-Dunkerques, 35000 Rennes, France. Electronic address: vincent.lavoue@chu-rennes.fr. · Service de gynécologie, CHI Poissy, 78000 Poissy, France. · Service de gynécologie, hôpital Hautepierre, CHU Strasbourg, 67000 Strasbourg, France. · Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France. · Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service de gynécologie, groupe hospitalier Diaconesses Croix Saint Simon, 75020 Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France. · Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France. · Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France. · Pôle Femmes-Parents-Enfants-Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; IMBE UMR 7263, Aix-Marseille université, CNRS, IRD, Avignon université, 13397 Marseille, France. · Service d'oncologie médicale, Centre Eugène Marquis, 35000 Rennes, France. · Service d'anatomopathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France. · Service d'oncologie chirurgicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France. · Service de radiologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France. · Service d'oncologie médicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France. · Service de chirurgie, institut Gustave Roussy, 94000 Villejuif, France. · Service de chirurgie, institut Bergonié, 33000 Bordeaux, France. · Service de chirurgie, institut Paoli Calmette, 13000 Marseille, France. · Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France. · Service de chirurgie gynécologique et oncologique, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France. · Service d'anatomopathologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France. · Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France. · Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France. · Service de méthodologie, institut Bergonié, 33000 Bordeaux, France. · Service de chirurgie, Curie (site Saint Cloud), 75000 Paris, France. · Service d'oncologie médicale, Centre Léon Bérard, 69000 Lyon, France. · Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France. · Service de radiologie, hôpital Tenon, AP-HP, 75020 Paris, France. · Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France. · Service d'oncologie médicale, institut de cancérologie des hospices Civils de Lyon, Pierre-Bénite, 69000 Lyon Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #30686724.

ABSTRACT: Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).

23 Guideline [Follow-up of patients treated for an epithelial ovarian cancer, place of hormone replacement therapy and of contraception: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. 2019

Sénéchal, C / Akladios, C / Bendifallah, S / Ouldamer, L / Lecuru, F / Rousset-Jablonski, C. ·Institut Bergonié, 33000 Bordeaux, France. Electronic address: c.senechal-davin@bordeaux.unicancer.fr. · CHU de Hautepierre, 67000 Strasbourg, France. · Hôpital Tenon, AP-HP, 75020 Paris, France. · CHU Bretonneau, 37000 Tours, France. · Hôpital européen Georges Pompidou, AP-HP, 75015 Paris, France. · Centre Léon Bérard, Lyon, Centre Hospitalier Lyon Sud, 69000 Lyon, France. ·Gynecol Obstet Fertil Senol · Pubmed #30685388.

ABSTRACT: OBJECTIVES: To define follow-up modalities after an epithelial ovarian, tubal or primitive peritoneal cancer. To define possibilities of hormone replacement therapy (HRT) and contraceptive use after treatment. METHODS: Systematic review of the literature in French and English langage conducted on Pubmed/Medline and the Cochrane Library. RESULTS: After the treatment of an epithelial ovarian, tubal or primitive peritoneal cancer, symptoms evaluation for follow-up is recommended at 3 months, 6 months, 12 months, 18 months, 24 months, and then yearly (Grade B). Only patients with an initial complete surgery (CC0, without any macroscopic signs of disease), and with a good general condition (ECOG 0) should be followed with paraclinic tests, with a serum HE4 or CA125 concentration measurement, from 6 months after the end of treatments (GradeC). Systematic follow-up with CT of the chest, abdomen, and pelvis is not recommended (GradeC). Imaging test is recommended in case of an increased serum concentration of HE4 or CA125 (Grade B). An HRT should be proposed to women younger than 45 after a non-conservative treatment for a high grade serous (GradeC) or for a mucinous (GradeC) ovarian, tubal or primitive peritoneal adenocarcinoma. HRT is not contra-indicated in women older than 45 presenting a climacteric syndrome after the treatment of a high grade serous (Grade B) or of a mucinous (GradeC) ovarian, tubal or primitive peritoneal adenocarcinoma.

24 Guideline Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2018

Ray-Coquard, I / Morice, P / Lorusso, D / Prat, J / Oaknin, A / Pautier, P / Colombo, N / Anonymous5171149. ·Centre Leon Bérard, University Claude Bernard Lyon & GINECO group, Lyon. · Gustave Roussy & GINECO group, Villejuif, France. · Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. · Hospital de Sant Pau, Autonomous University of Barcelona. · Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. · University of Milan-Bicocca and European Institute of Oncology, Milan, Italy. ·Ann Oncol · Pubmed #32169220.

ABSTRACT: -- No abstract --

25 Guideline No. 366-Gynaecologic Management of Hereditary Breast and Ovarian Cancer. 2018

Jacobson, Michelle / Bernardini, Marcus / Sobel, Mara L / Kim, Raymond H / McCuaig, Jeanna / Allen, Lisa. ·Toronto, ON. ·J Obstet Gynaecol Can · Pubmed #30473125.

ABSTRACT: OBJECTIVE: This Committee Opinion outlines the gynaecologic management recommendations for women diagnosed with hereditary breast and ovarian cancer syndrome (HBOC) with respect to screening, contraception, chemoprophylaxis, fertility considerations, risk-reducing surgery, and post-oophorectomy care. INTENDED USERS: This Committee Opinion is designed for gynaecologic oncologists, general gynaecologists, family physicians, genetic counsellors, registered nurses, nurse practitioners, residents, and health care providers. TARGET POPULATION: Adult women (18 years and older) with a pathogenic germline variant in the BRCA1, BRCA2, and other ovarian cancer-associated genes. EVIDENCE: While reviewing evidence, databases searched include Medline, Cochrane, and PubMed. Medical Subject Heading search terms used include BRCA AND gynaecology management, hormone replacement therapy, risk reduction, chemoprophylaxis, fertility from 01/2010 and 10/2017. Literature search was begun 07/2017 and finalized 10/2017. In total 183 studies were identified, and 101 were used. VALIDATION METHODS: The content and recommendations were drafted and agreed upon by the principal authors. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework (Table 1). The interpretation of strong and conditional (weak) recommendations is described in Table 2. The Summary of Findings is available upon request. BENEFITS, HARMS, AND COSTS: We may expect a risk reduction of up to 90% in women predisposed to HBOC who undergo risk-reducing bilateral salpingo-oophorectomy. The harms of iatrogenic premature menopause are offset by the benefits of risk reduction. By minimizing potential tubal/ovarian/peritoneal cancers, we can expect savings to the health care system. GUIDELINE UPDATE: Evidence will be reviewed 5 years after publication to decide whether all or part of the opinion should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. SPONSORS: This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada.

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