Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study.
Publication Title
Gynecologic oncology
Document Type
Article
Publication Date
6-1-2018
Keywords
GOG; NRG; Ovarian cancer; Radiographic evaluation; Surgeon's assessment; Surgical cytoreduction; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy; Protocols/therapeutic use; Bevacizumab/therapeutic use; Carboplatin/administration & dosage; Cytoreduction Surgical Procedures/methods; Female; Humans; Middle Aged; Neoplasm Grading; Neoplasm Staging; Neoplasm, Residual/diagnosis; Neoplasm, Residual/diagnostic imaging; Neoplasm, Residual/pathology; Neoplasms, Glandular and Epithelial/diagnosis; Neoplasms, Glandular and Epithelial/diagnostic imaging; Neoplasms, Glandular and Epithelial/pathology; Neoplasms, Glandular and Epithelial/therapy; Ovarian Neoplasms/diagnosis; Ovarian Neoplasms/diagnostic imaging; Ovarian Neoplasms/pathology; Ovarian Neoplasms/therapy; Paclitaxel/administration & dosage; Young Adult
Abstract
PURPOSE: We sought to determine the level of concordance among surgeons' assessment of residual disease (RD) and pre-treatment computed tomography (CT) findings among women who underwent optimal surgical cytoreduction for advanced stage ovarian cancer.
METHODS: This is a post-trial ad hoc analysis of a phase 3 randomized clinical trial evaluating the impact of bevacizumab in primary and maintenance therapy for patients with advanced stage ovarian cancer following surgical cytoreduction. All subjects underwent imaging of the chest/abdomen/pelvis to establish a post-surgical baseline prior to the initiation of chemotherapy. Information collected on trial was utilized to compare surgeon's operative assessment of RD, to pre-treatment imaging.
RESULTS: Of 1873 enrolled patients, surgical outcome was described as optimal (RD≤1cm) in 639 subjects. Twelve patients were excluded as they did not have a baseline, pretreatment imaging, leaving 627 participants for analysis. The average interval from surgery to baseline scan was 26days (range: 1-109). In 251 cases (40%), the post-operative scan was discordant with surgeon assessment, demonstrating RD>1cm in size. RD>1cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal para-aortic lymph nodes (RD>1.5cm; 28.2%) and the left upper quadrant (10.7%). Patients with RD>1cm on pre-treatment CT (discordant) exhibited a significantly greater risk of disease progression (HR 1.30; 95% CI 1.08-1.56; p=0.0059).
CONCLUSIONS: Among patients reported to have undergone optimal cytoreduction, 40% were found to have lesions >1cm on postoperative, pretreatment imaging. Although inflammatory changes and/or rapid tumor regrowth could account for the discordance, the impact on PFS and distribution of RD may suggest underestimation by the operating surgeon.
Area of Special Interest
Cancer
Area of Special Interest
Women & Children
Specialty/Research Institute
Oncology
Specialty/Research Institute
Obstetrics & Gynecology
Specialty/Research Institute
Surgery
