title: Multidisciplinary approach in the management of advanced ovarian cancer patients: A personalized approach. Results from a specialized ovarian cancer unit.
abstract: The aim of the present study was to evaluate the impact of a multidisciplinary approach in patients' selection with advanced ovarian cancer (AOC) for different therapeutic strategies.
  
  
  
  Patients referred at our institution between 2009 and 2012 for AOC were included. Primary multidisciplinary evaluation was performed in all patients. Different strategies included: 1. patients referred to primary neoadjuvant chemotherapy (NACT) and interval surgery (IDS) (group A); 2. patients considered for surgical exploration. After surgical exploration, patients were either considered for primary debulking (PDS; group B), or NACT (group C).
  
  
  
  A total of 363 patients were included. Of 38 patients (10.5%) in group A, 24 (63%) had sovradiaphragmatic/multiple liver metastases; 14 (37%) were excluded for PDS for anestehesiologic/medical reasons. Of 325 (89.5%) considered for surgical exploration, 295 (91%; group B) had primary surgery with debulking intent (N: 277) and were cytoreduced to no macroscopic disease (R0: N:200; 68%) o minimal RD<5mm (R1: N:77; 26%) or palliative intent (N:18; 6%); 30 (9%; group C) were referred for NACT. Of those, 27 (90%) underwent IDS, 3 had progressive disease. Overall survival (OS) and progression free survival (PFS) was different between the groups: OS: Group A: 34months; Group B: 59months; Group C: 29months; p<0.001. PFS: Group A: 10months; Group B; 21months; Group C: 12months; p<0.001.
  
  
  
  A multidisciplinary approach to patients referred to a tertiary center with AOC allows optimization of the treatment strategy, based on patients' characteristics (age, performance/nutritional status, comorbidities, functional status) and tumor diffusion (evaluated pre- and intraoperatively).
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy. Electronic address: giovanni.aletti@ieo.it.
authors.forename: Giovanni Damiano
authors.initials: GD
authors.lastname: Aletti
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Garbi
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Messori
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Achilarre
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Vanna
authors.initials: V
authors.lastname: Zanagnolo
authors.affiliation: Department of Radiology, European Institute of Oncology, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.affiliation: Department of Radiology, European Institute of Oncology, Milan, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Alessi
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bocciolone
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.affiliation: Department of General Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.affiliation: Department of Pathology, European Institute of Oncology, Milan, Italy.
authors.forename: Silvestro
authors.initials: S
authors.lastname: Carinelli
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
authors.affiliation: Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods*; D055815:Young Adult