Epithelial ovarian cancer remains one of the most aggressive gynaecological malignancies, which in most cases is diagnosed at advanced stages. The aim of the study was to present a staged treatment of a patient with advanced high-grade serous ovarian carcinoma, demonstrating the value of multimodal diagnostics, laparoscopic determination of the peritoneal carcinomatosis index, assessment of morphological response, and integrated chemo-surgical tactics in accordance with the ESGO/ESMO 2023 recommendations. A 45-year-old patient with bilateral ovarian lesions, ascites, and a high carcinomatosis index (24) underwent a comprehensive examination that included ultrasound, computed tomography, magnetic resonance imaging, endoscopic methods, laparoscopy with biopsy, and in-depth morphological analysis (histology, immunohistochemistry, assessment of Ki-67, estrogen receptor expression, and angiogenic markers). Pathohistological examination demonstrated a high degree of therapeutic pathomorphosis: a sharp decrease in Ki-67 (up to 2-5%), single tumour cells against a background of pronounced fibrosis, a decrease in microvascular density and the presence of xanthoma cells in areas of previous necrosis. Postoperative adjuvant treatment provided a stable response without signs of progression. The treatment results demonstrated the effectiveness of a staged treatment strategy for advanced ovarian cancer, which combined laparoscopic assessment of resectability, neoadjuvant polychemotherapy, interval cytoreduction and morphological verification of the response. The results obtained confirmed the high prognostic informativeness of the carcinomatosis index, Ki-67 and morphological markers of regression. The findings of the work can be used by gynaecological oncologists, chemotherapists, and pathologists in specialised oncology and university clinics when planning and assessing the effectiveness of staged treatment of advanced epithelial ovarian cancer
Banakhevych et al. (2026) studied this question.