Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Gynecol Cancer. 2019 Jan;29(1):174-180. doi: 10.1136/ijgc-2018-000018.
Low grade serous ovarian carcinoma is a rare subtype of ovarian cancer with an indolent and chemorefractory course. As such, treatment strategies among practitioners are not uniformly known. The primary objective of this study was to identify differences in practice patterns among physicians who treat low grade serous carcinoma.
A de novo survey was distributed to members of the Society of Gynecologic Oncology. Questions about demographics, management of primary and recurrent disease, and use of consolidation therapy were included. Statistical analyses were performed using χ and Fisher's exact tests.
194 gynecologic oncologists completed the survey. Approximately two-thirds of respondents practiced in a university based setting and treated a high volume of ovarian cancers, including low grade serous carcinoma. 82% recommended somatic testing during treatment and 84% routinely sent patients for genetic counseling. Treatment preferences for primary disease varied by debulking status. 48% of practitioners used hormone antagonism as consolidation after primary treatment. Secondary cytoreduction was preferred for patients with platinum sensitive recurrence and a long disease free interval following primary treatment (P<0.001). Hormone antagonism was the preferred treatment for the first platinum resistant recurrence (54%), while a BRAF inhibitor was the preferred agent in platinum resistant recurrence in the presence of a known BRAF mutation (56%).
There was significant variation in the preferred management of low grade serous carcinoma among practitioners. Further efforts to improve knowledge of this disease, identify optimal treatment modalities, and provide guidelines for management should be encouraged.
低级别浆液性卵巢癌是一种罕见的卵巢癌亚型，其病程呈惰性且对化疗耐药。因此，临床医生的治疗策略并不统一。本研究的主要目的是确定治疗低级别浆液性癌的医生之间在实践模式上的差异。
一项新的调查被分发给妇科肿瘤学会的成员。调查问卷包括人口统计学、原发性和复发性疾病的管理以及巩固治疗的使用等问题。采用卡方检验和 Fisher 确切概率法进行统计分析。
194 名妇科肿瘤学家完成了调查。约三分之二的受访者在大学附属医院工作，治疗大量卵巢癌，包括低级别浆液性癌。82%的医生建议在治疗期间进行体细胞检测，84%的医生常规为患者提供遗传咨询。原发性疾病的治疗偏好因减瘤状态而异。48%的医生在原发性治疗后使用激素拮抗剂作为巩固治疗。对于铂类敏感复发且原发性治疗后无疾病间期较长的患者，首选二次细胞减灭术（P<0.001）。对于首次铂类耐药复发，首选激素拮抗剂（54%），而对于存在已知 BRAF 突变的铂类耐药复发，首选 BRAF 抑制剂（56%）。
在低级别浆液性癌的治疗管理方面，医生之间存在显著的差异。应鼓励进一步努力提高对这种疾病的认识，确定最佳治疗方式，并为管理提供指南。
