2024-07-29 09:17:17
In France, each year ovarian cancer affects nearly 5,900 women and leads to approximately 3,500 deaths. A statement from the National Academy of Medicine tempers this sad report by highlighting the ” significant ” progress made in its management over the past thirty years.
The first of these is molecular dismemberment, which allows the identification of several types of ovarian cancers, guiding therapeutic strategies. The Academy gives the example of the search for anomalies in the repair of double-strand breaks in DNA, associated or not with deleterious mutations of the BRCA1 and 2 genes (BReast CAncer). This research is now essential for the prescription of targeted therapies, particularly that of Poly-ADP-Ribose-Polymerase inhibitors (iPARP), which have “revolutionized the treatment of certain aggressive cancers.“
The second progress is the improvement in the quality of surgical management. Exploratory laparoscopy allows an assessment of the condition of the abdominal cavity and the performance of biopsies for histological and molecular analyses. Subsequently, a complete excision is performed (either from the start or after chemotherapy) to avoid leaving tumor residues, which conditions the recurrence at a distance. Finally, the prevention of post-operative complications is a major issue.
“Large-scale trials” recommended
The experience of the surgical team is fundamental, which leads to the third progress: the certification of expert centers based on minimum activity thresholds and numbers of surgeons. Based on the recommendations of the European Society of Gynecologic Oncology (ESGO), it imposes a minimum activity threshold of 20 cases of ovarian cancer treated per year per surgeon, with a target of at least 50 cases per year per surgeon over five years and a staffing of at least two surgeons per establishment.
Data from the PMSI (Programme de médicalisation des systèmes d’information) showed that in 2016, about 3,700 surgical interventions for advanced ovarian cancer were performed in France. However, only 11 establishments had performed more than 50, and many institutions performed fewer than 10. This observation led to an evolution in the regulatory conditions for the authorization of these activities, allowing numerous establishments to ensure an activity level exceeding 20 annual cases of surgery for advanced ovarian cancer.
In conclusion, the Academy recommends “large-scale clinical trials” and the gathering of “expertise from several high-expertise disciplines“, preferably in healthcare establishments designated as referral centers for this pathology. Lastly, it advocates for an “adjustment” of the organization of care across the national territory “so that patients with a suspicion or a confirmed diagnosis of ovarian cancer can access these referral establishments as quickly as possible.“
Future Trends in Ovarian Cancer Treatment and Management
The ongoing battle against ovarian cancer continues to evolve, as recent advances highlight significant improvements in diagnosis, treatment, and surgical management. With approximately 5,900 women diagnosed annually in France, the medical community is focusing on harnessing innovative strategies to enhance patient outcomes.
One of the most promising trends is the refinement of molecular profiling in ovarian cancer. By identifying specific subtypes of the disease through molecular disaggregation, healthcare providers can tailor treatment strategies more effectively. The emphasis on genetic testing for anomalies, particularly in DNA repair mechanisms linked to BRCA1 and BRCA2 mutations, opens the door to targeted therapies. The rise of PARP inhibitors, which have transformed the landscape for treating aggressive cancers, showcases the potential for personalized medicine in oncology.
The surgical landscape is also witnessing progressive transformations. The adoption of exploratory laparoscopy allows for thorough assessments of the abdominal cavity. This technique, combined with comprehensive tumor resections, aims to significantly reduce the likelihood of residual disease—a major contributor to recurrence. Furthermore, advancements in post-operative care are crucial, as minimizing complications can enhance recovery and improve long-term survival rates.
Certification of Expert Centers
As the complexity of ovarian cancer management increases, the certification of specialized centers emerges as a key trend. The establishment of minimum activity thresholds for surgical oncologists ensures that patients receive care from experienced teams. With guidelines recommending that each surgeon handles at least 20 cases per year, this shift aims to centralize expertise and uphold high standards of care across facilities. Data revealing that many hospitals are not meeting these benchmarks underline the need for regulatory reforms to ensure that more institutions can qualify for such certifications.
Looking ahead, there is a call for expansive clinical trials that leverage multidisciplinary expertise. Collaborative efforts across various medical fields within designated healthcare facilities are essential. This will not only promote rigorous research but also facilitate rapid access to cutting-edge treatments for patients diagnosed with ovarian cancer. Improved organizational frameworks for healthcare delivery across regions will ensure timely interventions, which are vital for better prognosis in patients with suspected or confirmed cases.