Global consensus for the screening, diagnosis, staging, treatment, and surveillance of ovarian cancer in areas of significant resource limitations: Report from the International Gynecological Cancer Society consensus meeting

Fernando Maluf¹Henrique Alkalay Helber^1*Francinne Tostes¹Ligia Arteaga Maluf¹Juliana Karassawa Helito¹Renato Moretti-Marques¹Graziela Zibetti Dal Molin²Bruno Roberto Braga Azevedo³David Isla Ortiz⁴David Cantu⁴Agnaldo Lopes Silva Filho⁵ANGELICA NOGUEIRA-RODRIGUES⁵Reitan Ribeiro⁶Georgia Fontes Cintra⁷Gustavo Guitmann⁸Andreia Cristina de Melo⁸Eduardo Paulino⁸Glauco Baiocchi Neto⁹LEANDRO RESENDE³Michelle Samora de Almeida¹⁰Diocesio Alves Pinto de Andrade³Julio Lau de la Vega¹¹Florencia Noll¹²Fabio Fin¹³Andre Lopes⁹Miguel Enrique Matute Correa¹⁴Joseph S Ng¹⁵Daniel Sanabria¹⁶Gabriel Rendon¹⁷Fernando Heredia¹⁸Ana Paula E. Galerani Lopes¹⁹Myriam Beatriz Perotta Mussi²⁰Marcin Bobinski²¹Milagros Perez Quintanilla²²Jimena Meymar²³David Atallah²⁴Audrey Tsunoda²⁵

• ¹Hospital Israelita Albert Einstein, São Paulo, Brazil
• ²Beneficencia Portuguesa de Sao Paulo, São Paulo, Brazil
• ³Oncoclinicas do Brasil, São Paulo, Brazil
• ⁴Sociedad Medica del Instituto Nacional de Cancerologia, Mexico City, Mexico
• ⁵Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
• ⁶McGill University, Montreal, Canada
• ⁷Instituto Brasileiro de Controle do Cancer, São Paulo, Brazil
• ⁸Instituto Nacional de Cancer, Rio de Janeiro, Brazil
• ⁹A C Camargo Cancer Center, São Paulo, Brazil
• ¹⁰Hospital do Coracao, São Paulo, Brazil
• ¹¹Gynecare Womens Health Clinic, Guatemala City, Guatemala
• ¹²Sanatorio Allende Ginecologia y Obstetricia, Córdoba, Argentina
• ¹³Centro de Oncologia do Parana Ltda, Curitiba, Brazil
• ¹⁴Onco Prevee, Lima, Peru
• ¹⁵National University Cancer Institute, Singapore, Singapore
• ¹⁶Fundacion Universitaria de Ciencias de la Salud, Bogotá, Colombia
• ¹⁷Instituto de Cancerologia, Medellín, Colombia
• ¹⁸Instituto Oncologico Fundacion Arturo Lopez Perez, Providencia, Chile
• ¹⁹Sultan Qaboos Comprehensive Cancer Care & Research Center, Muscat, Oman
• ²⁰Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
• ²¹Uniwersytet Medyczny w Lublinie, Lublin, Poland
• ²²Asociacion Medica del Centro Medico ABC, Mexico City, Mexico
• ²³Kenes Israel, Lod, Israel
• ²⁴Hotel-Dieu de France, Beirut, Lebanon
• ²⁵Hospital Erasto Gaertner, Curitiba, Brazil

Introduction: The objective of this consensus report is to provide practical, resource-stratified recommendations for the management of ovarian cancer in countries with limited resources, where direct application of international guidelines is often difficult. To address these challenges, recommendations were developed from a panel of international experts. Methods: The panel met in New York in September/October 2022 during the International Gynecological Cancer Society congress and was composed of specialists from countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 72 questions and provided recommendations for the diagnosis, staging, treatment, and surveillance of ovarian cancer. Consensus was defined as at least 75% of the voting members selecting a particular recommendation, whereas a majority vote was considered when one option garnered between 50% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or funding for providing modern medical care. Results: Consensus was reached for 10 out of 72 (13.9%) questions presented to the panel, whereas a majority vote was reached for 26 (36.1%) additional questions. For the remaining questions, there was considerable heterogeneity in the recommendations. Conclusion: The development of guidelines focusing on areas facing more severe resource limitations may improve medical practice and patient care.