Advanced Ovarian Cancer Managed with NACT Followed by Interval Debulking Surgery

Case Vlog
A 50-year-old woman presented with features suggestive of advanced ovarian malignancy. On evaluation, she was diagnosed with high-grade serous carcinoma (HGSC) of the ovary, with a markedly elevated CA-125 level of 1200.

Given the advanced disease burden, the patient was started on neoadjuvant chemotherapy (NACT). She completed planned cycles and showed an excellent clinical and biochemical response.

A post-NACT CT scan revealed a significant reduction in disease load, and her CA-125 levels dropped from 1200 to 56, indicating a good response to chemotherapy.

Considering this favorable response, we proceeded with interval debulking surgery (IDS).

Intraoperatively, optimal cytoreduction was achieved. The procedure included:
– Total abdominal hysterectomy (TAH)
– Bilateral salpingo-oophorectomy (BSO)
– Total omentectomy
– Bilateral parietal peritonectomy
– Subdiaphragmatic stripping

The goal of achieving no gross residual disease was accomplished. The patient tolerated the procedure well, and postoperative recovery was uneventful.
Take-Home Message
Neoadjuvant chemotherapy followed by interval debulking surgery is an effective strategy in advanced ovarian cancer, allowing optimal cytoreduction and improved outcomes when primary surgery is not feasible initially.

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