- Author
-
R. van de Vrie
- Title
- Treatment selection in advanced ovarian cancer
- Supervisors
-
G.G. Kenter
- Co-supervisors
-
C.A.R. Lok
P. Tajik - Award date
- 2 September 2020
- Number of pages
- 242
- ISBN
- 9789402820171
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
In this thesis, we evaluated different prediction models predicting the outcome of cytoreductive surgery to facilitate treatment selection for patients with advanced stage ovarian cancer. Treatment options are primary cytoreductive surgery follow by chemotherapy, or neoadjuvant chemotherapy combined with interval surgery. We investigated different prediction models, based on CT scan, laparoscopy, clinical parameters and serum biomarkers.
We performed two systematic reviews of the literature to investigate all literature on the subject and to define the remaining knowledge gaps. We developed and externally validated a new model based on CT scan parameters. In a randomized clinical trial we found that incorporation of a diagnostic laparoscopy in the work-up before start of treatment for advanced stage ovarian cancer patients prevents futile laparotomies, without increasing health care costs. And performed the external validation of different prediction models. Furthermore, we evaluated the new subdivision of stage IV in IVA and IVB and suggested a different subdivision based on lymph node metastasis instead of pleural effusion.
All different models are combined in a decision tree for treatment selection, to aid the clinical implementation of the described models. - Persistent Identifier
- https://hdl.handle.net/11245.1/d10f76b9-d188-4fb0-b0b8-1f9f598874fc
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of this thesis
Chapter 2: Predicting surgical outcome in patients with international federation of gynecology and obstetrics stage III or IV ovarian cancer using computed tomography; A systematic review of prediction models
Chapter 3: Prediction of surgical outcome after primary cytoreductive surgery in patients with ovarian cancer using computed tomography, development and external validation of a model
Chapter 4: Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa): a randomized controlled trial
Chapter 5: Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer (Review)
Chapter 6: Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer
Chapter 7: Validation of a treatment-selection rule for patients with advanced stage ovarian cancer
Chapter 8: Pre-operative prediction of residual disease after interval cytoreduction for epithelial ovarian cancer using HE4
Chapter 9: FIGO stage IVA versus IVB of ovarian cancer: Prognostic value and predictive value for neoadjuvant chemotherapy
Chapter 10: Discussion and future perspective
Summary; Nederlandse samenvatting; List of authors; Portfolio; List of publications; Dankwoord; Curriculum vitae
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