How do you factor a decreasing but persistently elevated CA-125 into your decision regarding whether to proceed with interval cytoreductive surgery for PAX8+ high-grade serous cancer s/p neoadjuvant chemotherapy with minimal disease on imaging?  

I don’t let the CA-125 influence my decision to perform interval debulking. If the patient has had a good radiologic response to neoadjuvant chemotherapy and has minimal disease on imaging, I proceed with interval debulking with the goal of an R0 resection regardless of the CA-125.

While a rapid decline in CA-125 often portends a better response to chemotherapy, it is not the sole factor on which I decide to operate or not. I rely more on imaging response to make a decision about interval cytoreduction. If there has been a good radiographic response, I will proceed with surger...