Development of an evidence-based algorithm for the management of ovarian cancer.

OBJECTIVE: To describe the management of ovarian cancer to be undertaken by a gynaecologist and to describe the highest level of primary research evidence supporting it. DESIGN: Use of regional guidelines and semi-structured interviews with gynaecological oncologists to devise a flow-chart algorithm for management. Use of an algorithm to identify the key research questions and to define search strategies for primary research, which was assessed using pre-defined criteria for validity. MAIN OUTCOME MEASURES: Highest level of evidence for each research question based on the design of the valid studies. RESULTS: Prospective cohort studies (level II-2A) support the algorithm's diagnostic procedures. The evidence for accurate staging is derived from case series data (level II-2B). Preserving the uterus in young women wishing to maintain fertility is supported by prospective cohort studies (level II-2A) and by case series data (level IV) for women with germ cell tumours. Prospective cohort studies (level II-2A) support surgical management with hysterectomy, bilateral oophorectomy and debulking. The evidence for chemotherapy comes from randomised controlled trials (level I), except for germ cell tumours where the evidence was from case series data (level IV). CONCLUSIONS: The management of ovarian cancer and the level of evidence supporting it can be described using a flow-chart algorithm. Evaluations of whether this presentation helps consultants follow guidelines are required.