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How to Evaluate Tumor Burden Before Therapeutic Decision

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Ovarian Cancers

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Abstract

Absent residual tumor after primary debulking surgery is one of the main prognostic factors in advanced ovarian cancer. However, complete resection is very difficult to obtain, due to the wide spread diffusion of the disease both within the abdominal cavity on peritoneal surfaces, and to the liver/spleen, or far to the lung, brain and lymphnodes. Predicting successful surgical outcome depends on many variables including patients’ characteristics, serum markers, and disease extension. Here we describe more advanced techniques to assess pre-operative tumor burden, ongoing clinical trials and integrated clinical models to individualize therapeutic decision.

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References

  1. Fathalla MF. Incessant ovulation and ovarian cancer – a hypothesis re-visited. Facts Views Vis Obgyn. 2013;5(4):292–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Tan D, Agarwal R, Kaye SB. Mechanisms of transcoelomic metastasis in ovarian cancer. Lancet. 2006;7:925–34.

    Article  PubMed  Google Scholar 

  3. Dauplat J, Hacker NF, Nieberg R, et al. Distant metastases in epithelial ovarian carcinoma. Cancer. 1987;60:1561–6.

    Article  CAS  PubMed  Google Scholar 

  4. Aletti GD, Santillan A, Eisenhauer EL, Hu J, Aletti G, Podratz KC, Bristow RE, Chi DS, Cliby WA. A new frontier for quality of care in gynecologic oncology surgery: multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. Gynecol Oncol. 2007;107(1):99–106.

    Article  PubMed  Google Scholar 

  5. Barlin JN, Yu C, Hill EK, Zivanovic O, Kolev V, Levine DA, Sonoda Y, Abu-Rustum NR, Huh J, Barakat RR, Kattan MW, Chi DS. Nomogram for predicting 5-year disease-specific mortality after primary surgery for epithelial ovarian cancer. Gynecol Oncol. 2012;125(1):25–30.

    Article  PubMed  Google Scholar 

  6. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55.

    Article  CAS  PubMed  Google Scholar 

  7. Rosen DG, Wang L, Atkinson JN, Yu Y, Lu KH, Diamandis EP, Hellstrom I, Mok SC, Liu J, Bast Jr RC. Potential markers that complement expression of CA125 in epithelial ovarian cancer. Gynecol Oncol. 2005;99(2):267–77.

    Article  CAS  PubMed  Google Scholar 

  8. Chi DS, Venkatraman ES, Masson V, Hoskins WJ. The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol. 2000;77:227–31.

    Article  CAS  PubMed  Google Scholar 

  9. Chi DS, Zivanovic O, Palayekar MJ, Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Leitao MM, Brown CL, Barakat RR. A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma. Gynecol Oncol. 2009;112(1):6–10.

    Article  CAS  PubMed  Google Scholar 

  10. Kang S, Kim TJ, Nam BH, Seo SS, Kim BG, Bae DS, Park SY. Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis. J Surg Oncol. 2010;101(1):13–7.

    Article  CAS  PubMed  Google Scholar 

  11. Pelissier A, Bonneau C, Chéreau E, de La Motte RT, Fourchotte V, Daraï E, Rouzier R. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2014;135(3):542–6.

    Article  CAS  PubMed  Google Scholar 

  12. Rodriguez N, Rauh-Hain JA, Shoni M, Berkowitz RS, Muto MG, Feltmate C, Schorge JO, Del Carmen MG, Matulonis UA, Horowitz NS. Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol. 2012;125(2):362–6.

    Article  CAS  PubMed  Google Scholar 

  13. Braicu EI, Fotopoulou C, Van Gorp T, Richter R, Chekerov R, Hall C, Butz H, Castillo-Tong DC, Mahner S, Zeillinger R, Concin N, Vergote I, Sehouli J. Preoperative HE4 expression in plasma predicts surgical outcome in primary ovarian cancer patients: results from the OVCAD study. Gynecol Oncol. 2013;128(2):245–51.

    Article  CAS  PubMed  Google Scholar 

  14. Suidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Mironov S, Iyer RB, Zhou Q, Iasonos A, Paul H, Hosaka M, Aghajanian CA, Leitao Jr MM, Gardner GJ, Abu-Rustum NR, Sonoda Y, Levine DA, Hricak H, Chi DS. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol. 2014;134(3):455–61. doi:10.1016/j.ygyno.2014.07.002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Jung DC, Kang S, Kim SC, Kim JW, Nam JH, Ryu SY, Seong SJ, Kim BG. Use of complex surgical procedures, patterns of tumor spread, and CA-125 predicts a risk of incomplete cytoreduction: a Korean Gynecologic Oncology Group study (KGOG-3022). Gynecol Oncol. 2013;131(2):336–40.

    Article  PubMed  Google Scholar 

  16. Tucker SL, Gharpure K, Herbrich SM, Unruh AK, Nick AM, Crane EK, Coleman RL, Guenthoer J, Dalton HJ, Wu SY, Rupaimoole R, Lopez-Berestein G, Ozpolat B, Ivan C, Hu W, Baggerly KA, Sood AK. Molecular biomarkers of residual disease after surgical debulking of high-grade serous ovarian cancer. Clin Cancer Res. 2014;20(12):3280–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Valentin L. Prospective cross-validation of Doppler ultrasound examination and gray-scale ultrasound imaging for discrimination of benign and malignant pelvic masses. Ultrasound Obstet Gynecol. 1999;14:273–83.

    Article  CAS  PubMed  Google Scholar 

  18. Fischerova D, Burgetova A. Imaging techniques for the evaluation of ovarian cancer. Best Pract Res Clin Obstet Gynaecol. 2014;28(5):697–720.

    Article  PubMed  Google Scholar 

  19. Testa AC, Ludovisi M, Savelli L, Fruscella E, Ghi T, Fagotti A, Scambia G, Ferrandina G. Ultrasound and color power Doppler in the detection of metastatic omentum: a prospective study. Ultrasound Obstet Gynecol. 2006;27(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  20. Zikan M, Fischerova D, Pinkavova I, Dundr P, Cibula D. Ultrasound-guided tru-cut biopsy of abdominal and pelvic tumors in gynecology. Ultrasound Obstet Gynecol. 2010;36:767–72.

    Article  CAS  PubMed  Google Scholar 

  21. Timmerman D, Schwärzler P, Collins WP, et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol. 1999;13:11–6.

    Article  CAS  PubMed  Google Scholar 

  22. Medeiros LR, Stein AT, Fachel J, Garry R, Furness S. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer. 2008;18(3):387–99.

    Article  CAS  PubMed  Google Scholar 

  23. Stevens SK, Hricak H, Stern JL. Ovarian lesions: detection and characterization with gadolinium-enhanced MR imaging at 1.5 T. Radiology. 1991;181(2):481–8.

    Article  CAS  PubMed  Google Scholar 

  24. Michielsen K, Vergote I, Op de Beeck K, et al. Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT. Eur Radiol. 2014;24:889–901.

    Article  PubMed  Google Scholar 

  25. Low RN, Gurney J. Diffusion-weighted MRI (DWI) in the oncology patient: value of breathhold DWI compared to unenhanced and gadolinium-enhanced MRI. J Magn Reson Imaging. 2007;25:848–58.

    Article  PubMed  Google Scholar 

  26. Low RN, Sebrechts CP, Barone RM, et al. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings–a feasibility study. AJR Am J Roentgenol. 2009;193:461–70.

    Article  PubMed  Google Scholar 

  27. Kyriazi S, Collins DJ, Morgan VA, et al. Diffusion-weighted imaging of peritoneal disease for noninvasive staging of advanced ovarian cancer. Radiographics. 2010;30:1269–85.

    Article  PubMed  Google Scholar 

  28. Wakefield JC, Downey K, Kyriazi S, et al. New MR techniques in gynecologic cancer. AJR Am J Roentgenol. 2013;200:249–60.

    Article  PubMed  Google Scholar 

  29. Ricke J, Sehouli J, Hach C, Hänninen EL, Lichtenegger W, Felix R. Prospective evaluation of contrast-enhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer. Eur Radiol. 2003;13(5):943–9.

    PubMed  Google Scholar 

  30. Kyriazi S, Kaye SB, deSouza NM. Imaging ovarian cancer and peritoneal metastases–current and emerging techniques. Nat Rev Clin Oncol. 2010;7:381–93.

    Article  PubMed  Google Scholar 

  31. Bharwani N, Reznek RH, Rockall AG. Ovarian cancer management: the role of imaging and diagnostic challenges. Eur J Radiol. 2011;78:41–51.

    Article  PubMed  Google Scholar 

  32. Alt CD, Brocker KA, Eichbaum M, et al. Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 2. Strahlenther Onkol. 2011;187:705–14.

    Article  PubMed  Google Scholar 

  33. Kambadakone AR, Sahani DV. Body perfusion CT: technique, clinical applications, and advances. Radiol Clin North Am. 2009;47(1):161–78.

    Article  PubMed  Google Scholar 

  34. Forstner R, Sala E, Kinkel K, et al. ESUR guidelines: ovarian cancer staging and follow-up. Eur Radiol. 2010;20:2773–80.

    Article  PubMed  Google Scholar 

  35. Mitchell DG, Javitt MC, Glanc P, et al. ACR appropriateness criteria staging and follow-up of ovarian cancer. J Am Coll Radiol. 2013;10:822–7.

    Article  PubMed  Google Scholar 

  36. Forstner R, Hricak H, Occhipinti KA, et al. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;197(3):619–26.

    Article  CAS  PubMed  Google Scholar 

  37. Coakley FV, Choi PH, Gougoutas CA, et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology. 2002;223:495–9.

    Article  PubMed  Google Scholar 

  38. Kitajima K, Murakami K, Yamasaki E, et al. Diagnostic accuracy of integrated FDG-PET/contrast-enhanced CT in staging ovarian cancer: comparison with enhanced CT. Eur J Nucl Med Mol Imaging. 2008;35:1912–20.

    Article  PubMed  Google Scholar 

  39. Mitchell DG, Hill MC, Hill S, Zaloudek C. Serous carcinoma of the ovary: CT identification of metastatic calcified implants. Radiology. 1986;158(3):649–52.

    Article  CAS  PubMed  Google Scholar 

  40. Nelson BE, Rosenfield AT, Schwartz PE. Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol. 1993;11(1):166–72.

    CAS  PubMed  Google Scholar 

  41. Bristow RE, Duska LR, Lambrou NC, Fishman EK, O’Neill MJ, Trimble EL, Montz FJ. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer. 2000;89(7):1532–40.

    Article  CAS  PubMed  Google Scholar 

  42. Salani R, Axtell A, Gerardi M, Holschneider C, Bristow RE. Limited utility of conventional criteria for predicting unresectable disease in patients with advanced stage epithelial ovarian cancer. Gynecol Oncol. 2008;108(2):271–5.

    Article  PubMed  Google Scholar 

  43. Dowdy SC, Mullany SA, Brandt KR, Huppert BJ, Cliby WA. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer. 2004;101(2):346–52.

    Article  PubMed  Google Scholar 

  44. Ferrandina G, Sallustio G, Fagotti A, Vizzielli G, Paglia A, Cucci E, Margariti A, Aquilani L, Garganese G, Scambia G. Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial. Br J Cancer. 2009;101(7):1066–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Janco JM, Glaser G, Kim B, McGree ME, Weaver AL, Cliby WA, Dowdy SC, Bakkum-Gamez JN. Development of a prediction model for residual disease in newly diagnosed advanced ovarian cancer. Gynecol Oncol. 2015;138(1):70–7.

    Article  PubMed  Google Scholar 

  46. Rockall AG, Cross S, Flanagan S, et al. The role of FDG-PET/CT in gynaecological cancers. Cancer Imaging. 2012;12:49–65.

    Article  PubMed  PubMed Central  Google Scholar 

  47. De Iaco P, Musto A, Orazi L, et al. FDG-PET/CT in advanced ovarian cancer staging: value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy. Eur J Radiol. 2011;80:e98–103.

    Article  PubMed  Google Scholar 

  48. Dauwen H, Van Calster B, Deroose CM, Op de Beeck K, Amant F, Neven P, Berteloot P, Leunen K, Vergote I. PET/CT in the staging of patients with a pelvic mass suspicious for ovarian cancer. Gynecol Oncol. 2013;131(3):694–700.

    Article  CAS  PubMed  Google Scholar 

  49. Hynninen J, Kemppainen J, Lavonius M, et al. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol. 2013;131:389–94.

    Article  PubMed  Google Scholar 

  50. Fruscio R, Sina F, Dolci C, Signorelli M, Crivellaro C, Dell’Anna T, Cuzzocrea M, Guerra L, Milani R, Messa C. Preoperative 18F-FDG PET/CT in the management of advanced epithelial ovarian cancer. Gynecol Oncol. 2013;131(3):689–93.

    Article  PubMed  Google Scholar 

  51. Shim SH, Lee SJ, Kim SO, Kim SN, Kim DY, Lee JJ, Kim JH, Kim YM, Kim YT, Nam JH. Nomogram for predicting incomplete cytoreduction in advanced ovarian cancer patients. Gynecol Oncol. 2015;136(1):30–6.

    Article  PubMed  Google Scholar 

  52. Schmidt S, Meuli RA, Achtari C, Prior JO. Peritoneal carcinomatosis in primary ovarian cancer staging: comparison between MDCT, MRI, and 18F-FDG PET/CT. Clin Nucl Med. 2015;40(5):371–7.

    Article  PubMed  Google Scholar 

  53. Fader AN, Rose PG. Role of surgery in ovarian carcinoma. J Clin Oncol. 2007;25(20):2873–83.

    Article  PubMed  Google Scholar 

  54. Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg. 1995;221:124–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Eisenkop SM, Spirtos NM, Friedman RL, Lin WC, Pisani AL, Perticucci S. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 2003;90(2):390–6.

    Article  PubMed  Google Scholar 

  56. Fagotti A, Ferrandina G, Fanfani F, et al. A laparoscopy–based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol. 2006;13(8):1156–61.

    Article  PubMed  Google Scholar 

  57. Tentes AA, Tripsiannis G, Markakidis SK, et al. Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur J Surg Oncol. 2003;29:69–73.

    Article  PubMed  Google Scholar 

  58. Chéreau E, Ballester M, Selle F, et al. Comparison of peritoneal carcinomatosis scoring methods in predicting resectability and prognosis in advanced ovarian cancer. Am J Obstet Gynecol. 2010;202:178.e1–10.

    Article  Google Scholar 

  59. Vergote I, De Wever I, Tjalma W, Van Gramberen M, Decloedt J, van Dam P. Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol. 1998;71(3):431–6.

    Article  CAS  PubMed  Google Scholar 

  60. Fagotti A, Fanfani F, Ludovisi M, Lo Voi R, Bifulco G, Testa AC, et al. Role of laparoscopy to assess the chance of optimal cytoreductive surgery in advanced ovarian cancer: a pilot study. Gynecol Oncol. 2005;96:729–35.

    Article  PubMed  Google Scholar 

  61. Angioli R, Innocenza P, Marzio AZ, Natalina M, Ludovico M, Marco C, et al. Diagnostic open laparoscopic in the management of advanced ovarian cancer. Gynecol Oncol. 2006;100:455–61.

    Article  PubMed  Google Scholar 

  62. Brun JL, Rouzier R, Uzan S, Darai E. External validation of a laparoscopic-based score to evaluate resectability of advanced ovarian cancers: clues for a simplified score. Gynecol Oncol. 2008;110:354–9.

    Article  PubMed  Google Scholar 

  63. Fagotti A, Ferrandina G, Fanfani F, Garganese G, Vizzielli F, Carone V, et al. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. Am J Obstet Gynecol. 2008;199:642.e1–6.

    Article  PubMed  Google Scholar 

  64. Fagotti A, Vizzielli G, Constantini B, Lecca A, Gallota V, Gagliardi ML, et al. Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinomatosis in advanced ovarian cancer. Acta Obstet Gynecol Scand. 2011;90:1126–31.

    Article  PubMed  Google Scholar 

  65. Fagotti A, Vizzielli G, De Iaco P, Surico D, Buda A, Mandato VD, et al. A multicentric trial (Olympia-MITO13) on the accuracy of laparoscopy to assess peritoneal spread in ovarian cancer. Am J Obstet Gynecol. 2013;209:462.e1-11.

    Article  Google Scholar 

  66. Fagotti A, Vizzielli G, Fanfani F, Costantini B, Ferrandina G, Gallotta V, et al. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. Gynecol Oncol. 2013;131:341–6.

    Article  CAS  PubMed  Google Scholar 

  67. Vizzielli G, Costantini B, Tortorella L, Petrillo M, Fanfani F, Chiantera V, et al. Influence of intraperitoneal dissemination assessed by laparoscopy on prognosis of advanced ovarian cancer: an exploratory analysis of a single-institution experience. Ann Surg Oncol. 2014;21:3970–7.

    Article  PubMed  Google Scholar 

  68. Rutten MJ, Leeflang MM, Kenter GG, Mol BW, Buist M. Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. Cochrane Database Syst Rev. 2014;(2):CD009786.

    Google Scholar 

  69. Petrillo M, Vizzielli G, Fanfani F, Gallotta V, Cosentino F, Chiantera V, Legge F, Carbone V, Scambia G, Fagotti A. Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: proof of a concept. Gynecol Oncol. 2015;139(1):5–9.

    Google Scholar 

  70. Rutten MJ, Gaarenstroom KN, Van Gorp T, van Meurs HS, Arts HJ, Bossuyt PM, et al. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study. BMC Cancer. 2012;12:31.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Fagotti A, Ferrandina G, Vizzielli G, Fanfani F, Gallotta V, Chiantera V, Costantini B, Margariti PA, Gueli Alletti S, Cosentino F, Tortorella L, Scambia G. Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): Final analysis of peri-operative outcome. Eur J Cancer. 2016;59:22–33.

    Google Scholar 

  72. Nick AM, Ramirez PT, Sood AK. A framework for personalized surgical approach to ovarian cancer. Nat Rev Clin Oncol. 2015;12(4):239-45. http://dx.doi.org/10.1038/nrclinionc. (in press).

  73. Gómez-Hidalgo NR, Martinez-Cannon BA, Nick AM, Lu KH, Sood AK, Coleman RL, Ramirez PT. Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: time to incorporate laparoscopic assessment into the standard of care. Gynecol Oncol. 2015;137(3):553–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Gynecologic Oncology, Department Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy

    Anna Fagotti, Luigi Pedone Anchora, Mara Pacciani & Giovanni Scambia

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  1. Anna Fagotti
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  2. Luigi Pedone Anchora
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  3. Mara Pacciani
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  4. Giovanni Scambia
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Correspondence to Anna Fagotti .

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Editors and Affiliations

  1. AP-HP, Hôtel-Dieu, Paris, France

    Eric Pujade-Lauraine

  2. Centre Léon Bérard, Université Claude Bernard, Lyon, France

    Isabelle Ray-Coquard

  3. Chirurgie cancérologique, HEGP, Paris, France

    Fabrice Lécuru

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Fagotti, A., Anchora, L.P., Pacciani, M., Scambia, G. (2017). How to Evaluate Tumor Burden Before Therapeutic Decision. In: Pujade-Lauraine, E., Ray-Coquard, I., Lécuru, F. (eds) Ovarian Cancers. Springer, Cham. https://doi.org/10.1007/978-3-319-32110-3_4

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