Introduction

Ovarian cancer is one of the most lethal gynecologic malignancies [1], largely due to its asymptomatic progression and lack of effective early detection methods. Approximately 75% of patients are diagnosed at an advanced stage, and most cases are the high-grade serous ovarian cancer (HGSOC) subtype, which accounts for about 70% of epithelial ovarian cancers [2]. Although initial responses to standard treatment—optimal cytoreductive surgery followed by paclitaxel-platinum chemotherapy—are generally favorable, recurrence within 3 years is common and often fatal [3].

To improve long-term outcomes, several modifications and additions to standard first-line therapy have been investigated. Dose-dense weekly paclitaxel-based chemotherapy demonstrated significantly improved survival compared to the standard 3-weekly paclitaxel regimen in Japanese patients, as shown in the Japanese Gynecologic Oncology Group (JGOG) 3016 trial [4]. However, similar survival benefits were not observed in subsequent Western trials (Multicentre Italian Trials in Ovarian Cancer [MITO]-7, International Collaborative Ovarian Neoplasm [ICON]8, and Gynecologic Oncology Group [GOG]-262) [5-7]. Several factors may explain these discrepancies. Firstly, pharmacogenomic differences between East Asian and Western populations have been documented in the context of paclitaxel metabolism and toxicity profiles. For example, ethnic variability in CYP2C8 and ABCB1 polymorphisms—key enzymes and transporters involved in paclitaxel clearance—has been documented [8]. CYP2C8 variants that reduce paclitaxel metabolism are more common in Western populations than in East Asians [9], while ABCB1 polymorphisms affecting drug efflux have been associated with altered paclitaxel exposure in Japanese patients [8]. Secondly, population-specific differences may underlie the inconsistent outcomes observed across trials [10]. The proportion of East Asian patients in these Western trials was low, limiting the generalizability of the findings to Asian populations [6]. Given the close genetic similarities between Korean and Japanese populations [11], this background provided a rationale for exploring the potential relevance of the dose-dense regimen in Korean clinical settings.

In certain cases, such as unresectable metastatic lymph nodes, local radiotherapy may serve as an effective treatment modality [12-14]. Advances in radiation planning and imaging, such as positron emission tomography-computed tomography (PET-CT), allow more precise targeting of disease sites. Adjuvant radiotherapy prior to poly(ADP-ribose) polymerase (PARP) inhibitor maintenance may contribute to improved locoregional control, particularly in patients with microscopic residual disease [15].

PARP inhibitors have emerged as a key component of maintenance therapy, especially in patients with pathogenic or likely pathogenic BRCA mutations or homologous recombination deficiency (HRD) [16,17]. Their integration into first-line treatment has demonstrated improved survival across multiple clinical trials, establishing them as standard of care in selected patients [18,19].

This study aims to evaluate the real-world outcomes of a sequential first-line treatment strategy involving cytoreductive surgery, followed by dose-dense weekly paclitaxel-carboplatin chemotherapy, selective adjuvant radiotherapy for unresectable nodal disease, and PARP inhibitor maintenance therapy in patients with newly diagnosed advanced HGSOC.

Methods

Ethical statements: The Institutional Review Board (IRB) of Kosin University Gospel Hospital (IRB No. 2025-06-030) determined that this study was exempt from formal review. Because the analysis was retrospective and relied exclusively on deidentified clinical data, the requirement for informed consent was waived.

1. Patients

In this retrospective study, we reviewed the medical records of 12 patients with advanced HGSOC who received dose-dense weekly paclitaxel-carboplatin chemotherapy, selective adjuvant radiotherapy, and PARP inhibitor maintenance therapy following cytoreductive surgery at Kosin University Gospel Hospital (Busan, Korea) between December 2019 and March 2023. Patient characteristics are summarized in Table 1.

Among the 12 patients, 11 underwent primary debulking surgery (PDS) followed by nine cycles of dose-dense weekly paclitaxel (80 mg/m²) and three weekly carboplatin (area under the curve [AUC] 6) chemotherapy. One patient received six cycles of neoadjuvant chemotherapy consisting of weekly paclitaxel (80 mg/m²) and 3-weekly carboplatin (AUC 6) prior to interval debulking surgery (IDS), followed by six additional cycles of the same dose-dense regimen. Chemotherapy schedules were adjusted based on hematologic parameters. Treatment was delayed or dose was reduced if the absolute neutrophil count (ANC) dropped below 500/µL or platelet count was less than 80,000/µL. Therapy continued as scheduled when ANC ≥1,000/µL and platelets ≥100,000/µL unless contraindicated.

Genomic DNA was extracted from peripheral blood leukocytes. BRCA1 (22 exons) and BRCA2 (26 exons) genes were analyzed using Sanger sequencing. Variant classification was based on the 2015 American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines. Pathogenic and likely pathogenic variants were classified as “mutation-positive,” while patients without such variants were classified as “wild-type.” Variants of uncertain significance were not detected in our cohort.

2. Selective adjuvant radiotherapy

All patients underwent PET-CT before surgery to evaluate lymph node metastasis. For patients with International Federation of Gynecology and Obstetrics (FIGO) stage IVB disease and suspected unresectable lymph node metastasis, fine-needle aspiration (FNA) was performed to confirm involvement. Based on preoperative imaging, radiotherapy was considered for lymph nodes larger than 1 cm confined to a limited anatomical region.

The decision to administer selective adjuvant radiotherapy was made by a multidisciplinary team, including a gynecologic oncologist, medical oncologist, and gynecologic oncology radiologist, following completion of chemotherapy and prior to PARP inhibitor maintenance. Among the nine patients with stage IVB disease, eight had distant lymph node metastases, and one had colon metastasis. Initial adjuvant radiotherapy was administered to five patients, targeting metastatic lymph nodes. In patients with FIGO stage IVB disease with distant lymph node metastases, we considered selective adjuvant radiotherapy based on the location and size of metastatic lymph nodes.

Radiotherapy was primarily directed to high-risk lesions such as the upper para-aortic lymph nodes (above the inferior mesenteric artery) and neck (cervical or supraclavicular) nodes greater than 1 cm in diameter, as identified through PET-CT or FNA biopsy. The clinical target volume encompassed the entire metastatic nodal lesion. A total dose of 45.0–50.4 Gy was delivered in 25–28 fractions of 1.8 Gy per fraction. Radiotherapy was delivered following debulking surgery and chemotherapy but prior to initiation of PARP inhibitor maintenance. PARP inhibitor maintenance therapy was started after completion of chemotherapy, with or without selective adjuvant radiotherapy (Table 1).

3. Surveillance and endpoints

Patients were monitored by three weekly cancer antigen 125 levels and imaging (magnetic resonance imaging, ultrasound, or computed tomography) every 3 months. Primary endpoints were progression-free survival (PFS), overall survival (OS), and recurrence. PFS was defined as the time from diagnosis to radiologically confirmed recurrence. OS was defined as the time from diagnosis to death from any cause.

Results

Twelve patients with advanced HGSOC were included in this study (Table 1). The median age at diagnosis was 55 years (range, 41–73 years). Nine patients had FIGO stage IVB disease and three had stage IIIC. BRCA mutations were identified in six patients (50.0%)—three with BRCA1 and three with BRCA2 mutations—while the remaining six patients were BRCA wild-type. All patients underwent cytoreductive surgery: 11 received PDS and one underwent IDS after neoadjuvant chemotherapy. The residual tumor size was >1 cm in seven patients (58.3%) and ≤1 cm in five patients (41.7%). Patients were followed for a median of 48.1 months (range, 28.7–66.5 months).

All patients received dose-dense weekly paclitaxel-carboplatin chemotherapy. Chemotherapy dosage was summarized using delivered dose intensity (DDI) and reduced dose intensity (RDI) across all patients. A total of seven patients (58.3%) completed nine cycles of dose-dense chemotherapy without dose reduction, achieving a DDI of 900% and RDI of 0%. The remaining five patients (41.7%) required dose modifications, with DDI ranging from 720% to 1,080% and corresponding RDI values from 80% to 180%, reflecting individualized adjustments based on clinical tolerance or hematologic toxicity. Targeted therapy with PARP inhibitors was initiated in all cases: niraparib in nine patients and olaparib in three. Among the nine patients with stage IVB disease, five received selective adjuvant radiotherapy targeting distant lymph node metastases (e.g., supraclavicular or para-aortic lymph nodes) after chemotherapy and prior to maintenance therapy (Table 1).

During follow-up, four patients (33.3%) experienced recurrence (Table 1). All had FIGO stage IVB disease, residual tumor >1 cm and BRCA1 mutations were identified in two patients. Two had also received selective adjuvant radiotherapy. Notably, all recurrences occurred outside the irradiated fields. The median PFS among the four recurrent patients was 43 months. Salvage treatments included surgery (n=1), radiotherapy (n=2), and chemotherapy (n=4). At final follow-up, all four recurrent patients were alive and had achieved a no-evidence-of-disease (NED) state (Table 1).

Table 2 provides information on the prevalence of treatment-related adverse events, each graded according to the Common Terminology Criteria for Adverse Events (CTCAE) 5.0. Bone marrow suppression was the most common toxicity during dose-dense chemotherapy, with neutropenia observed in 75.0% of patients (grade 3 in 41.7%), thrombocytopenia in 91.7% (grade 1–2 in 91.7%, no grade ≥3), and anemia in 58.3% (grade 3 in 16.7%). During PARP inhibitor therapy, hematologic toxicity was minimal, with only mild neutropenia (16.7%), thrombocytopenia (33.3%), and anemia (16.7%) observed. Among all chemotherapy cycles, any-grade treatment-emergent adverse events neutropenia, thrombocytopenia, and anemia were reported in 29.9%, 23.5%, and 23.5% of events, respectively. These were primarily attributed to chemotherapy and managed effectively using supportive agents such as granulocyte colony-stimulating factor (G-CSF; filgrastim) and granulocyte-macrophage colony-stimulating factor (GM-CSF). Alopecia (CTCAE grade 1‒2) occurred in all patients receiving chemotherapy but was fully reversible after completion of chemotherapy.

Chronic adverse effects were peripheral neuropathy and extremity edema. Peripheral neuropathy occurred in 83.3% of patients following dose-dense chemotherapy, although all cases were grade 1–2. No patient experienced grade 3 or higher neuropathy. Limb edema was reported in 33.3% of patients after surgery and in 20.0% of patients following radiotherapy. All cases were mild (grade 1–2) (Table 2).

The median follow-up duration was 48.1 months (range, 28.7–66.5 months) (Table 1). All patients achieved complete remission after first-line sequential treatment, and no deaths were reported at the time of data cutoff (June 20, 2025). Five patients survived more than 5 years, and eight more than 3 years. The median OS was not reached.

The median PFS was 43.8 months, and the upper limit of the 95% confidence interval (CI) was not reached (Fig. 1). Compared to PFS values from previous dose-dense chemotherapy trials (Table 3), this result is notably favorable. However, due to the small sample size and relatively limited number of events and short follow-up period, statistical significance could not be determined.

Discussion

Optimal cytoreductive surgery remains the most critical prognostic factor in advanced ovarian cancer. Two surgical approaches are commonly used: PDS and IDS, both of which aim to achieve maximal cytoreduction [20]. While complete cytoreduction (no visible residual disease) is ideal, it is often unachievable in advanced-stage cases. Studies have shown that reducing residual disease to less than 1 cm is associated with a significant survival benefit. When optimal cytoreduction is not feasible, neoadjuvant chemotherapy followed by IDS is a viable alternative. Recent studies have demonstrated that IDS after neoadjuvant chemotherapy provides survival outcomes comparable to PDS and may offer a survival advantage in advanced-stage disease [21-23]. In our study, all 12 operations were performed by a single gynecologic oncologic surgeon with the assistance of general and urologic surgeons to ensure maximal cytoreduction. Eleven patients underwent PDS, and one received IDS. Efforts were made to reduce the residual tumor burden to ≤1 cm, in line with optimal cytoreductive goals.

Second, dose-dense weekly paclitaxel chemotherapy has been explored as an alternative to the conventional three weekly regimen in first-line treatment. While the efficacy of 3-week paclitaxel and platinum chemotherapy following cytoreductive surgery is well established, its limitations have led to the exploration of dose-dense regimens. The JGOG 3016 trial conducted in Japan compared the conventional regimen (three weekly paclitaxel 180 mg/m²+carboplatin AUC 6) with a dose-dense regimen (weekly paclitaxel 80 mg/m²+three weekly carboplatin AUC 6) in patients with FIGO stage II–IV epithelial ovarian, primary peritoneal, or fallopian tube cancer [4]. Interpretation of these findings suggests that dose-dense paclitaxel therapy improves long-term survival in Japanese patients with epithelial ovarian cancer, particularly in those with extensive residual disease and serous histology. However, no benefit was observed in patients with clear cell carcinoma or mucinous carcinoma. Hematologic toxicity was a major concern in most patients receiving dose-dense therapy. Genetic and pharmacogenomic differences may influence treatment efficacy, underscoring the need for further investigation. Subsequent trials in Western populations, including the MITO-7 and ICON8 studies in Europe and the GOG-262 study in the United States, failed to confirm consistent survival benefits of weekly dose-dense paclitaxel in non-Japanese women with stage II–IV disease [5-7]. Neither MITO-7 nor ICON8 found significant difference in PFS between the weekly and conventional arms. In GOG-262, overall PFS was also not significantly different between groups; however, among patients not receiving bevacizumab (n=112), weekly paclitaxel was associated with a 4-month improvement in PFS (hazard ratio [HR], 0.62; 95% CI, 0.40–0.95; p=0.03) [10-12]. These discrepancies may reflect ethnic pharmacogenomic differences and suggest that weekly dose-dense paclitaxel treatment could be a potentially viable first-line option in East Asian populations. Based on this evidence, our institution adopted the dose-dense weekly paclitaxel-carboplatin regimen for 12 patients with advanced HGSOC. The main treatment-related toxicities were bone marrow suppression, alopecia, and peripheral neuropathy. Hematologic toxicity, particularly leukopenia, was effectively managed with proactive use of hematopoietic growth factors such as G-CSF and GM-CSF. These agents stimulate hematopoietic stem cells and enhance neutrophil production, preventing severe neutropenia and reducing the risk of sepsis. Regarding peripheral neuropathy, eight patients (66.7%) experienced grade 1–2 symptoms, which were tolerable and did not require pharmacologic intervention. Two patients (grade 3) reported persistent neuropathy requiring pharmacologic management.

A variety of targeted therapies is being developed to improve survival and response rates in patients with advanced ovarian cancer. Among these, PARP inhibitors have been extensively studied. Clinical trials have demonstrated that PARP inhibitors significantly improve survival outcomes and treatment response [16,17,24], and they are now established as standard maintenance therapy for patients with advanced ovarian cancer [25,26]. The recognition of BRCA1 and BRCA2 mutations and HRD as key molecular vulnerabilities has served as the foundation for introducing PARP inhibitors into frontline treatment [27]. Analyses from The Cancer Genome Atlas reveal that HRD occurs in roughly 50% of epithelial ovarian cancer, underscoring its clinical relevance for targeted therapies [28]. PARP inhibition leads to the accumulation of DNA damage, and cells with BRCA mutations or HRD are unable to repair these lesions, ultimately leading to cell death—a phenomenon known as synthetic lethality [29]. The PARP inhibitors olaparib, niraparib, and rucaparib are currently approved and have demonstrated efficacy in both frontline and recurrent ovarian cancer settings. Maintenance therapy with these agents has been shown in key clinical trials to markedly prolong PFS. For patients with BRCA-mutated advanced ovarian cancer, the SOLO1 study reported that olaparib reduced the risk of progression or death by about 70% compared with placebo (HR, 0.30; 95% CI, 0.23–0.41). In the PRIMA trial, niraparib extended PFS in the overall population regardless of biomarker status, with an HR of 0.62 (95% CI, 0.50–0.76) versus placebo. PARP inhibitors are considered manageable in terms of safety, even though a modest rise in serious adverse events has been observed. Common adverse effects include anemia, neutropenia, fatigue, vomiting, and nausea, typically mild to moderate in severity. The risk of myelodysplastic syndrome and acute myeloid leukemia appears low and is observed primarily in recurrent disease [26]. Further study is warranted to monitor long-term safety, including myelosuppression and secondary malignancies [30]. In the present study, PARP inhibitors included niraparib in nine patients and olaparib in three. BRCA mutations were detected in six of the 12 patients. Among the four recurrent patients, BRCA mutations were present in two. PARP inhibitor-related side effects were minimal and tolerable in our cohort.

Complete tumor resection is often unfeasible, especially in cases with lymph node metastases that are unresectable during PDS. In such situations, adjuvant therapies including chemotherapy, targeted therapy, and radiotherapy should be considered. Adjuvant radiotherapy can serve as an alternative to surgical resection for distant metastatic lymph nodes that are unresectable, such as upper para-aortic, intrathoracic, and cervical lymph nodes [12,14,15]. Advances in radiotherapy techniques allow precise targeting of metastatic lymph nodes while sparing uninvolved tissue, potentially preventing locoregional recurrence [14,31]. Selective adjuvant radiotherapy before PARP inhibitor maintenance may help reduce recurrence. PET-CT is essential for accurate identification of metastatic lymph nodes. From a molecular perspective, even when complete response is observed on imaging, microscopic residual disease may persist, supporting the rationale for radiotherapy [13,14]. At our institution, five of nine patients with stage IVB disease received initial adjuvant radiotherapy targeting metastatic lymph nodes. Among these, two experienced recurrence—but all recurrences occurred outside the irradiated fields. These findings suggest potential efficacy of adjuvant radiotherapy for unresectable nodal metastases and support its possible role as a future standard modality. Current advanced radiotherapy allows effective disease control while sparing healthy tissue. All four patients who experienced recurrence are currently alive and in a NED state following second-line treatment. Salvage therapy included surgery (n=1), radiotherapy (n=2), and chemotherapy (n=1), with ongoing systemic therapy.

This study has several limitations. First, as a retrospective, single-institution study, it is subject to inherent bias, including selection and information biases. Second, the small sample size of only 12 patients may limit generalizability. Third, the median follow-up less than 48.1 months may be insufficient to capture long-term outcomes and late complications. Last, the absence of a control group restricts causal inference. Despite these limitations, this study offers valuable insights. Expanding the cohort and increasing the sample size could produce statistically robust results.

A sequential treatment strategy combining optimal cytoreductive surgery, dose-dense chemotherapy, selective radiotherapy, and PARP inhibitor maintenance resulted in favorable outcomes in advanced HGSOC. All patients achieved complete remission, with a median PFS of 43.8 months and no in-field recurrences. While limited by sample size and follow-up duration, these preliminary findings suggest the potential value of this approach and merit further prospective validation.

Article information

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Funding

This study was supported by a grant from Kosin University College of Medicine (2025).

Author contributions

Conceptualization: ETK, WGK. Data curation: ETK, SYM, WGK. Formal analysis: ETK, WGK. Funding acquisition: ETK. Investigation: SYM. Methodology: ETK, WGK. Project administration: ETK, WGK. Resources: WGK, DHK. Software: ETK. Supervision: TKK, THL. Validation: WGK. Visualization: ETK. Writing-original draft: ETK, WGK. Writing-review & editing: all authors. All authors have read and approved the final manuscript.

Fig. 1.

Progression-free survival (PFS) of patients receiving the sequential treatment strategy. CI, confidence interval.

References

• 1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024;74:229–63.ArticlePubMed
• 2. Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin 2018;68:284–96.ArticlePubMedPMCPDF
• 3. Mahmood RD, Morgan RD, Edmondson RJ, Clamp AR, Jayson GC. First-line management of advanced high-grade serous ovarian cancer. Curr Oncol Rep 2020;22:64.ArticlePubMedPMCPDF
• 4. Katsumata N, Yasuda M, Isonishi S, Takahashi F, Michimae H, Kimura E, et al. Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial. Lancet Oncol 2013;14:1020–6.ArticlePubMed
• 5. Chan JK, Brady MF, Penson RT, Huang H, Birrer MJ, Walker JL, et al. Weekly vs. every-3-week paclitaxel and carboplatin for ovarian cancer. N Engl J Med 2016;374:738–48.ArticlePubMedPMC
• 6. Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DM, et al. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treatment (ICON8): primary progression free survival analysis results from a GCIG phase 3 randomised controlled trial. Lancet 2019;394:2084–95.ArticlePubMedPMC
• 7. Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, De Placido S, et al. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2014;15:396–405.ArticlePubMed
• 8. Yamaguchi H, Hishinuma T, Endo N, Tsukamoto H, Kishikawa Y, Sato M, et al. Genetic variation in ABCB1 influences paclitaxel pharmacokinetics in Japanese patients with ovarian cancer. Int J Gynecol Cancer 2006;16:979–85.ArticlePubMed
• 9. Dai D, Zeldin DC, Blaisdell JA, Chanas B, Coulter SJ, Ghanayem BI, et al. Polymorphisms in human CYP2C8 decrease metabolism of the anticancer drug paclitaxel and arachidonic acid. Pharmacogenetics 2001;11:597–607.ArticlePubMed
• 10. Marchetti C, De Felice F, Musella A, Palaia I, Monti M, Musio D, et al. Weekly versus three weeks chemotherapy for advanced ovarian cancer: a meta-analysis. Oncotarget 2016;7:58709–15.ArticlePubMedPMC
• 11. Kim J, Mizuno F, Matsushita T, Matsushita M, Aoto S, Ishiya K, et al. Genetic analysis of a Yayoi individual from the Doigahama site provides insights into the origins of immigrants to the Japanese Archipelago. J Hum Genet 2025;70:47–57.ArticlePubMedPDF
• 12. Hata M, Miyagi E, Koike I, Numazaki R, Asai-Sato M, Kasuya T, et al. Radiation therapy for para-aortic lymph node metastasis from uterine cervical cancer. Anticancer Res 2015;35:4849–54.PubMed
• 13. Macchia G, Titone F, Restaino S, Arcieri M, Pellecchia G, Andreetta C, et al. Is it time to reassess the role of radiotherapy treatment in ovarian cancer? Healthcare (Basel) 2023;11:2413.ArticlePubMedPMC
• 14. Shaikh T, Churilla TM, Mantia-Smaldone GM, Chu C, Rubin SC, Anderson PR. The role of adjuvant radiation in lymph node positive endometrial adenocarcinoma. Gynecol Oncol 2016;141:434–9.ArticlePubMed
• 15. Kim ET, Oh SY, Ma SY, Lee TH, Kim WG. Selective adjuvant radiation therapy for distant lymph node metastasis in patients with stage 4B epithelial ovarian cancer: a case series. KMJ 2023;38:293–9.ArticlePDF
• 16. Gonzalez-Martin A, Pothuri B, Vergote I, DePont Christensen R, Graybill W, Mirza MR, et al. Niraparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2019;381:2391–402.ArticlePubMed
• 17. Moore K, Colombo N, Scambia G, Kim BG, Oaknin A, Friedlander M, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2018;379:2495–505.ArticlePubMed
• 18. DiSilvestro P, Banerjee S, Colombo N, Scambia G, Kim BG, Oaknin A, et al. Overall survival with maintenance olaparib at a 7-year follow-up in patients with newly diagnosed advanced ovarian cancer and a BRCA mutation: the SOLO1/GOG 3004 trial. J Clin Oncol 2023;41:609–17.ArticlePubMed
• 19. Monk BJ, Barretina-Ginesta MP, Pothuri B, Vergote I, Graybill W, Mirza MR, et al. Niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer: final overall survival results from the PRIMA/ENGOT-OV26/GOG-3012 trial. Ann Oncol 2024;35:981–92.ArticlePubMedPMC
• 20. Chang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol 2013;130:493–8.ArticlePubMed
• 21. Fago-Olsen CL, Ottesen B, Kehlet H, Antonsen SL, Christensen IJ, Markauskas A, et al. Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients?: a nationwide Danish study. Gynecol Oncol 2014;132:292–8.ArticlePubMed
• 22. Mueller JJ, Zhou QC, Iasonos A, O'Cearbhaill RE, Alvi FA, El Haraki A, et al. Neoadjuvant chemotherapy and primary debulking surgery utilization for advanced-stage ovarian cancer at a comprehensive cancer center. Gynecol Oncol 2016;140:436–42.ArticlePubMedPMC
• 23. Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943–53.ArticlePubMed
• 24. Monk BJ, Parkinson C, Lim MC, O'Malley DM, Oaknin A, Wilson MK, et al. A randomized, phase III trial to evaluate rucaparib monotherapy as maintenance treatment in patients with newly diagnosed ovarian cancer (ATHENA-MONO/GOG-3020/ENGOT-ov45). J Clin Oncol 2022;40:3952–64.ArticlePubMedPMC
• 25. Baradacs I, Teutsch B, Varadi A, Bila A, Vincze A, Hegyi P, et al. PARP inhibitor era in ovarian cancer treatment: a systematic review and meta-analysis of randomized controlled trials. J Ovarian Res 2024;17:53.ArticlePubMedPMCPDF
• 26. Hao J, Liu Y, Zhang T, He J, Zhao H, An R, et al. Efficacy and safety of PARP inhibitors in the treatment of advanced ovarian cancer: an updated systematic review and meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol 2021;157:103145.ArticlePubMed
• 27. Ray-Coquard I, Pautier P, Pignata S, Perol D, Gonzalez-Martin A, Berger R, et al. Olaparib plus bevacizumab as first-line maintenance in ovarian cancer. N Engl J Med 2019;381:2416–28.ArticlePubMed
• 28. Cancer Genome Atlas Research Network. Integrated genomic analyses of ovarian carcinoma. Nature 2011;474:609–15.ArticlePubMedPMCPDF
• 29. Farmer H, McCabe N, Lord CJ, Tutt AN, Johnson DA, Richardson TB, et al. Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature 2005;434:917–21.ArticlePubMedPDF
• 30. Morice PM, Leary A, Dolladille C, Chretien B, Poulain L, Gonzalez-Martin A, et al. Myelodysplastic syndrome and acute myeloid leukaemia in patients treated with PARP inhibitors: a safety meta-analysis of randomised controlled trials and a retrospective study of the WHO pharmacovigilance database. Lancet Haematol 2021;8:e122–34.ArticlePubMed
• 31. Rutten MJ, van de Vrie R, Bruining A, Spijkerboer AM, Mol BW, Kenter GG, et al. 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. Int J Gynecol Cancer 2015;25:407–15.ArticlePubMed

Figure & Data

References

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