IGCS Ramadan Nights-Session #4

Video Transcription

Video Summary

The final IGCS “Ramadan Nights” session (recorded for the IGCS Education360 portal) featured Dr. Pedro Ramirez (Chair of OB-GYN at MD Anderson and Editor-in-Chief of the International Journal of Gynecological Cancer) discussing management of advanced ovarian cancer and the implications of the TRUST trial, particularly during crisis conditions when operating capacity is limited.<br /><br />Hosts described how, during COVID-related constraints, many centers increased use of neoadjuvant chemotherapy (NACT) and delayed interval debulking—sometimes extending beyond three cycles—while maintaining cancer surgery access when possible.<br /><br />Dr. Ramirez reviewed the history of randomized trials comparing primary cytoreductive surgery vs NACT followed by interval debulking (EORTC, CHORUS, JCOG0602, SCORPION), noting they consistently showed no overall survival (OS) difference between approaches. TRUST was designed to address criticisms about surgical quality by restricting participation to high-volume expert centers and using OS as the primary endpoint. Despite higher surgical standards, TRUST still did not show an OS benefit for primary surgery. Although progression-free survival favored primary surgery, he emphasized that with a negative primary endpoint, secondary endpoints are exploratory and should not be used to claim definitive efficacy.<br /><br />Key themes included appropriate patient selection, the value of structured CT reporting and selective use of laparoscopy for resectability assessment, and the importance of avoiding unnecessary morbidity when R0 resection is unlikely. Discussion also highlighted generalizability concerns: even if such trials were positive, results from elite centers might not translate to lower-resource settings. The session concluded that evidence-based, individualized decision-making and clinical trial enrollment remain essential.

Asset Subtitle

Recorded on March 18, 2026

Keywords

advanced ovarian cancer

neoadjuvant chemotherapy (NACT)

primary cytoreductive surgery

interval debulking surgery

TRUST trial

overall survival endpoint

progression-free survival

R0 resection

resectability assessment laparoscopy

COVID-19 surgical capacity constraints