Title

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.

Document Type

Article

Publication Date

6-1-2018

Publication Title

Gynecologic oncology

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.

Clinical Institute

Cancer

Clinical Institute

Women & Children

Department

Oncology

Department

Obstetrics & Gynecology

Department

Surgery

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