**6. Conclusions**

The development of malignant ascites is probably dependent on a combination of factors, which disrupts the normal regulation of intraperitoneal fluid flow and the maintenance of a steady state in the peritoneal cavity. Each factor plays a greater or lesser role in each individual patient, so the results of available treatment alternatives are inconsistent. In advanced OC, palliation of symptomatic patients is the foremost goal, and elimination of fluid accumulation in a patient with these symptoms will certainly improve the patient's quality of life and may even prolong survival. However, effective palliation of malignant ascites remains a difficult management issue. Present treatments have been developed, particularly for malignant ascites, with the primary aim of prolonging the time until a need for subsequent paracentesis. Further clinical trials are therefore necessary in order to investigate the influence on ascites-triggered intervention not only for symptomatic relief but also for the prolongation of both PFS and OS. For the use of targeted therapeutics in malignant ascites (catumaxomab, bevacizumab, aflibercept), it is mandatory to select patients carefully and to identify their risk factors so that the incidence of adverse effects can be minimised. The identification of predictive clinical and biological factors that could be utilised to select patients with a greater likelihood of clinical benefit remains a high priority. With advances in our understanding of malignant ascites pathophysiology, more effective treatment strategies for malignant ascites and ovarian cancer will emerge in the future.

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