Care pathway · Surgical approach decision / Gynecology / Gynecologic oncology · for licensed clinicians

Recurrent Ovarian Cancer · Secondary Cytoreduction vs Systemic Therapy

Platinum-sensitive + AGO-positive (ECOG 0/no residual/ascites ≤500 ml) + completely resectable → secondary cytoreduction (DESKTOP III); platinum-resistant non-platinum single agent, no surgery.

Based on: DESKTOP III / NCCN · nodes are our own synthesis of the guideline's decision logic, not the guideline verbatim
Clinical takeaway

Platinum-resistant → non-platinum systemic therapy: Platinum-resistant (recurrence <6 months) → non-platinum single-agent chemotherapy ± bevacizumab; generally no secondary cytoreduction (agg…

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Step 1 · Platinum sensitivity + AGO/resectability
Platinum-sensitive (≥6 months after last platinum)? AGO score? Completely resectable?
💡 Positive AGO score = ECOG 0 + no residual after primary surgery + ascites ≤500 ml (predicts complete resection).

Full pathway

  1. [Decision] Platinum sensitivity + AGO/resectability
    Platinum-sensitive (≥6 months after last platinum)? AGO score? Completely resectable? (Positive AGO score = ECOG 0 + no residual after primary surgery + ascites ≤500 ml (predicts complete resection).)
    • Platinum-sensitive, AGO-positive, completely resectable → Platinum-sensitive resectable → secondary cytoreduction
    • Platinum-sensitive but not completely resectable/AGO-negative → Platinum-sensitive not resectable → platinum-based chemotherapy
    • Platinum-resistant (recurrence <6 months) → Platinum-resistant → non-platinum systemic therapy
  2. [End] Platinum-sensitive resectable → secondary cytoreduction
    Platinum-sensitive, AGO-positive, complete resection achievable → secondary cytoreductive surgery (SCS) + platinum-based chemotherapy (DESKTOP III: SCS improves OS, greatest benefit with complete resection) ± bevacizumab/PARP maintenance.
  3. [End] Platinum-sensitive not resectable → platinum-based chemotherapy
    Platinum-sensitive but not completely resectable/AGO-negative → platinum-based combination chemotherapy ± bevacizumab + PARP maintenance (BRCA/HRD); do not force surgery.
  4. [End] Platinum-resistant → non-platinum systemic therapy
    Platinum-resistant (recurrence <6 months) → non-platinum single-agent chemotherapy ± bevacizumab; generally no secondary cytoreduction (aggressive, little benefit); mainly palliative, encourage clinical trials.

Source guidelines & references

  • Secondary cytoreduction in recurrent ovarian cancer (AGO DESKTOP III; NCCN; platinum-sensitivity stratification)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

⚠️ This pathway is for clinical reference and teaching by licensed clinicians as decision support; it does not replace clinical judgement or individualized care. In emergencies, follow resuscitation protocols first.
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InterventionalEarly Pregnancy Viability Assessment (SRU 2013)Imaging / Obstetrics and gynecology / UltrasoundEctopic Pregnancy Ultrasound DiagnosisImaging / Obstetrics and gynecology / UltrasoundIntrauterine Adhesions (Asherman) Imaging DiagnosisImaging / Gynecology / Reproductive medicineHysterosalpingography (HSG) Tubal Patency AssessmentImaging / Gynecology / Reproductive medicineGestational Trophoblastic Neoplasia (GTN) Staging and RiskImaging / Gynecologic oncologyCervical Length · Cervical Insufficiency Transvaginal UltrasoundImaging / Obstetrics / UltrasoundOvarian Vein Thrombosis (Postpartum) ImagingImaging / Obstetrics / VascularFetal Ventriculomegaly MRIImaging / Fetal medicine / Prenatal diagnosisFetal Agenesis of the Corpus Callosum MRIImaging / Fetal medicine / Prenatal diagnosisFetal Posterior Fossa Malformation MRI (Dandy-Walker Continuum)Imaging / Fetal medicine / Prenatal diagnosisCongenital Diaphragmatic Hernia (CDH) Fetal MRIImaging / Fetal medicine / Pediatric surgeryCongenital Pulmonary Airway Malformation (CPAM) Fetal · CVRImaging / Fetal medicine / Pediatric surgeryOpen Spina Bifida · Fetal Surgery Candidacy (MOMS)Imaging / Fetal medicine / Pediatric neurosurgeryDynamic Pelvic Floor MRI · Pelvic Organ Prolapse (HMO)Imaging / Gynecology / Pelvic floorCongenital Cytomegalovirus (CMV) Brain MRIImaging / Fetal medicine / Prenatal diagnosisSacrococcygeal Teratoma (Altman) Fetal MRIImaging / Fetal medicine / Pediatric surgeryFetal Neck Mass · EXIT AssessmentImaging / Fetal medicine / ENTHoloprosencephaly (HPE) Fetal MRIImaging / Fetal medicine / Prenatal diagnosisPulmonary Sequestration (BPS) Fetal MRIImaging / Fetal medicine / Pediatric surgeryFetal Lower Urinary Tract Obstruction (LUTO)Imaging / Fetal medicine / Pediatric urologyFetal Hydrops (Immune/Non-immune) Diagnostic WorkflowImaging / Fetal medicine / Maternal-fetal medicineTwin-Twin Transfusion Syndrome (TTTS · Quintero)Imaging / Fetal medicine / Maternal-fetal medicineFetal Abdominal Wall Defect (Gastroschisis vs Omphalocele)Imaging / Fetal medicine / Pediatric surgeryCongenital High Airway Obstruction (CHAOS)Imaging / Fetal medicine / ENTFetal Pleural Effusion / ChylothoraxImaging / Fetal medicine / Pediatric surgeryVein of Galen Aneurysmal Malformation (VGAM) Fetal MRIImaging / Fetal medicine / NeurointerventionFetal Malformation of Cortical Development (MCD) MRIImaging / Fetal medicine / Prenatal diagnosisFetal Microcephaly Diagnostic WorkflowImaging / Fetal medicine / Prenatal diagnosisFetal Aqueductal Stenosis (Obstructive Hydrocephalus)Imaging / Fetal medicine / Pediatric neurosurgeryFetal Intracranial Hemorrhage (IVH Grading)Imaging / Fetal medicine / Prenatal diagnosisFetal Encephalocele / Cranium BifidumImaging / Fetal medicine / Pediatric neurosurgeryFetal Tuberous Sclerosis (Rhabdomyomas + Brain Nodules)Imaging / Fetal medicine / Pediatric cardiologyFetal Abdominal Cyst Differential DiagnosisImaging / Fetal medicine / Pediatric surgeryFetal Gastrointestinal Obstruction Imaging DifferentiationImaging / Fetal medicine / Pediatric surgeryFetal Esophageal Atresia ± TEFImaging / Fetal medicine / Pediatric surgeryFetal Renal Anomaly (Cystic/Dysplastic)Imaging / Fetal medicine / Pediatric urologyFetal Skeletal Dysplasia (Lethality Prediction)Imaging / Fetal medicine / Clinical geneticsFetal Arachnoid Cyst / Midline CystImaging / Fetal medicine / Pediatric neurosurgeryFetal Hydronephrosis (UTD Classification)Imaging / Fetal medicine / Pediatric urologyFetal Adrenal/Retroperitoneal Mass DifferentiationImaging / Fetal medicine / Pediatric surgeryFetal Growth Restriction (FGR · Doppler)Imaging / Fetal medicine / Maternal-fetal medicineFetal Anemia (MCA-PSV)Imaging / Fetal medicine / Maternal-fetal medicineTwin Anemia-Polycythemia Sequence (TAPS)Imaging / Fetal medicine / Maternal-fetal medicineTwin Reversed Arterial Perfusion (TRAP · Acardiac Twin)Imaging / Fetal medicine / Maternal-fetal medicineFetal Goiter (Hypothyroid/Hyperthyroid)Imaging / Fetal medicine / Maternal-fetal medicine