Scripties UMCG - Rijksuniversiteit Groningen
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The accuracy of CT in predicting peritoneal tumor deposits for patients with advanced stage ovarian cancer,and its role in relation to outcome of cytoreductive surgery

(2011) Heijenk, Gemma

Introduction: Ovarian cancer is a major cause of gynaecologic cancer-related mortality. The most common and earliest mode of spread is intraperitoneal spread. At the time of diagnosis approximately 70% of women have advanced stage III or IV ovarian carcinoma. The cornerstone in therapy for advanced stage ovarian cancer is cytoreductive surgery combined with chemotherapy. Studies have demonstrated an inverse correlation between 5 year survival rate and residual mass after cytoreductive surgery.[1-5] Hence the great interest for the prediction of outcome of cytoreductive surgery. Since computed tomography is widely used for staging and most cost effective, the decision was made to use this modality for further research in this study.
The purpose of this retrospective study is to identify differences in tumor distribution as seen on pre-operative imaging with computed tomography and findings during surgery, for patients with stage IIIC and IV ovarian carcinoma who underwent neoadjuvant chemotherapy, and its correlation with outcome of surgery.

Patients and methods: In this retrospective study we looked at all patients with stage III/IV ovarian carcinoma who were treated with neoadjuvant chemotherapy and secondary cytoreductive surgery at the NKI-AvL between 2006 and 2011. The gold standard for presence, size and localization of tumor deposits are the per-operative findings at the beginning of the cytoreductive procedure. Tumor deposits were scored on special forms in eight abdominal regions. At the end of the cytoreductive procedure the amount of residual tumor was recorded in the same manner.
The CT-scans of all included patients were retrospectively reviewed and scored with the same forms used in surgery. Clinical findings extracted from the medical records; age, pre-operative CA125, presence of ascites and physical examination were also included.
The CT-scans combined with the clinical findings were discussed with a gynaecologic oncologist and based on all features combined it is decided what kind of resection (complete, optimal, suboptimal) seems possible. All data were entered in a database after which the results were analysed.

Results: Ninety six patients (76% stage IIIC, 24% stage IV)were included. Linear by linear association tests showed no association between physical examination, CA125, and amount of ascites on CT and outcome of resection. A sensitivity and specificity of CT is recorded varying from 4-88% and 15-96% respectively depending on location. The best results were booked in the greater omentum/transverse colon/spleen; sensitivity of 79%, specificity of 80%, and the worst in the sub-hepatic/omentum minus region; sensitivity and specificity of 4-95% respectively. Furthermore detection of tumor mass is more difficult for masses <1cm and peritonitis.

Conclusion: CT scan is less suitable for detecting peritoneal deposits of less than 1 cm and peritonitis of ovarian cancer. A reasonable correlation is present in tumor deposits located in greater omentum/ colon transversum/spleen. CT combined with clinical parameters can not be used as reliable predictors for the outcome of cytoreductive surgery

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