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Technologic Advances in Surgery for Brain Tumors: Tools of the Trade in the Modern Neurosurgical Operating Room

Christopher M. McPherson and Raymond Sawaya

Surgery is an essential part of the oncologic treatment of patients with brain tumors. Surgery is necessary for histologic diagnosis, and the cytoreduction of tumor mass has been shown to improve patient survival time and quality of life. Ultimately, the goal of any oncologic neurosurgery is to achieve maximal safe resection. Over the years, many technologic adjuncts have been developed to assist the surgeon in achieving this goal. In this article, we review the technologic advances of modern neurosurgery that are helping to reach this goal.

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Point: Intraperitoneal Chemotherapy in the Management of Ovarian Cancer

Maurie Markman

Both preclinical considerations and results of phase I safety and pharmacokinetic studies provided support for the argument that intraperitoneal antineoplastic drug delivery should be a rational approach to the management of ovarian cancer. Subsequently conducted phase II trials exploring regional treatment revealed surgically documented objective responses when the approach was employed as a second-line therapy. Recently, the results of three randomized phase III trials have shown that the use of primary cisplatin-based intraperitoneal therapy leads to superior survival compared with intravenous cisplatin-based treatment in patients with small-volume residual advanced ovarian cancer after initial surgical cytoreduction. Further exploration of this unique management strategy is indicated to develop an optimal approach that maintains the demonstrated enhanced efficacy while reducing the toxicity (principally because of cisplatin) of treatment.

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Intraperitoneal Chemotherapy for Ovarian Cancer: Where Are We Now?

Pankaj Singhal and Shashikant Lele

Patients with advanced epithelial ovarian cancer are conventionally treated with intravenous (IV) platinum- and taxane-based chemotherapy to try to eradicate residual disease after optimal cytoreductive surgery, resulting in a median overall survival of 49 months. The Gynecologic Oncology Group (GOG) conducted 3 large randomized, phase III clinical trials of intraperitoneal (IP) chemotherapy (GOG 104, 114, and 172) that clearly showed superior progression-free and overall survival with IP chemotherapy compared with IV chemotherapy. All 3 clinical trials investigated IP cisplatin, with the last one adding IP paclitaxel. The most recent study (GOG 172) resulted in a median survival of 66 months for patients in the IP arm versus 50 months for those in the IV arm. Fewer patients in the IP arm than in the IV arm completed all 6 treatment cycles (42% vs. 83%, respectively) because of the toxic effects of chemotherapy and IP catheter-related complications. Initially, patients in the IP arm reported significantly worse quality of life than those in the IV arm. However, at 12-month follow-up, the groups experienced no difference in quality of life, except that paresthesias were more likely to persist at moderate levels among patients in the IP arm. Based on these clinical trials, the National Cancer Institute issued a clinical announcement recommending that women with stage III ovarian cancer who undergo optimal surgical cytoreduction be considered for IP chemotherapy.

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Ovarian Cancer, Version 3.2012

Robert J. Morgan, Ronald D. Alvarez, Deborah K. Armstrong, Robert A. Burger, Mariana Castells, Lee-may Chen, Larry Copeland, Marta Ann Crispens, David Gershenson, Heidi Gray, Ardeshir Hakam, Laura J. Havrilesky, Carolyn Johnston, Shashikant Lele, Lainie Martin, Ursula A. Matulonis, David M. O’Malley, Richard T. Penson, Steven W. Remmenga, Paul Sabbatini, Joseph T. Santoso, Russell J. Schilder, Julian Schink, Nelson Teng, Theresa L. Werner, Miranda Hughes, and Mary A. Dwyer

) who are not surgical candidates. In select patients, NACT may be followed by interval cytoreduction (eg, NACT is given for 3 cycles followed by interval cytoreduction if possible, and then the remaining NACT regimen is given). For those having interval

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CLO20-068: Incidence and Potential Predictors of Thromboembolic Events in Epithelial Ovarian Carcinoma Patients During Perioperative Period

Qingqing Zhou, Chenchen Zhu, Zhen Shen, Jing Zhu, Tianjiao Zhang, Min Li, Jiwei Qin, Lili Qian, Chuan Chen, Hanyuan Liu, Zhihao Xu, Dabao Wu, Björn Nashan, and Ying Zhou

surgery. Patients with clear cell ovarian cancer had the highest incidence of VTE (26.32%) among all the pathology types. 81.82% of patients with VTE were at advanced stage (III and IV). After the primary cytoreduction surgery, 7.79% of patients developed

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NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019

Featured Updates to the NCCN Guidelines

Deborah K. Armstrong, Ronald D. Alvarez, Jamie N. Bakkum-Gamez, Lisa Barroilhet, Kian Behbakht, Andrew Berchuck, Jonathan S. Berek, Lee-may Chen, Mihaela Cristea, Marie DeRosa, Adam C. ElNaggar, David M. Gershenson, Heidi J. Gray, Ardeshir Hakam, Angela Jain, Carolyn Johnston, Charles A. Leath III, Joyce Liu, Haider Mahdi, Daniela Matei, Michael McHale, Karen McLean, David M. O’Malley, Richard T. Penson, Sanja Percac-Lima, Elena Ratner, Steven W. Remmenga, Paul Sabbatini, Theresa L. Werner, Emese Zsiros, Jennifer L. Burns, and Anita M. Engh

surgical candidate, optimal cytoreduction (residual disease <1 cm [R1] and preferably removal of macroscopic disease [R0]) appears feasible, and fertility is not a concern. Neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS) should be

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Indications for Minimally Invasive Surgery for Ovarian Cancer

Ernest S. Han and Mark Wakabayashi

goal of maximal cytoreduction. Minimally invasive surgery has evolved over the past several decades and is now commonly used for appendectomies and cholecystectomies. Minimally invasive surgery for gynecologic malignancies has been primarily focused

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Routine Imaging or No Routine Imaging, Is That the Question?

Laurie Elit, Gregory R. Pond, and Mark N. Levine

randomized trial on secondary surgical cytoreduction from the Gynecologic Oncology Group 2 again showed no benefit, which suggests that early detection of tumor recurrence would not affect survival. Thus, there appears to be strong evidence against the use

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Mesothelioma: Peritoneal, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology

David S. Ettinger, Douglas E. Wood, James Stevenson, Dara L. Aisner, Wallace Akerley, Jessica R. Bauman, Ankit Bharat, Debora S. Bruno, Joe Y. Chang, Lucian R. Chirieac, Malcolm DeCamp, Thomas J. Dilling, Jonathan Dowell, Gregory A. Durm, Scott Gettinger, Travis E. Grotz, Matthew A. Gubens, Aparna Hegde, Rudy P. Lackner, Michael Lanuti, Jules Lin, Billy W. Loo Jr, Christine M. Lovly, Fabien Maldonado, Erminia Massarelli, Daniel Morgensztern, Trey C. Mullikin, Thomas Ng, Gregory A. Otterson, Sandip P. Patel, Tejas Patil, Patricio M. Polanco, Gregory J. Riely, Jonathan Riess, Theresa A. Shapiro, Aditi P. Singh, Alda Tam, Tawee Tanvetyanon, Jane Yanagawa, Stephen C. Yang, Edwin Yau, Kristina M. Gregory, and Miranda Hughes

disease or low-volume biphasic disease (see “ Principles of Surgery ” in the algorithm, page 972). 78 It is essential that patients receive a careful assessment before surgery is performed. Complete cytoreduction is recommended for eligible patients with

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Current Evidence-Based Systemic Therapy for Advanced and Recurrent Endometrial Cancer

Sushmita Gordhandas, William A. Zammarrelli III, Eric V. Rios-Doria, Angela K. Green, and Vicky Makker

standard first-line (1L) therapy for newly diagnosed advanced/recurrent EC regardless of molecular subtype consists of carboplatin/paclitaxel (TC) chemotherapy with or without primary surgical cytoreduction. Key clinical trials assessing systemic therapy