Yuliya Lakhman MD, Presenter: Nothing to Disclose

Hedvig Hricak MD, PhD, Dr(hc), Abstract Co-Author: Nothing to Disclose

Oguz Akin MD, Abstract Co-Author: Nothing to Disclose

Harpreet Kaur Pannu MD, Abstract Co-Author: Nothing to Disclose

Michael Joseph Sohn, Abstract Co-Author: Nothing to Disclose

Junting Zheng, Abstract Co-Author: Nothing to Disclose

Chaya Moskowitz, Abstract Co-Author: Nothing to Disclose

Revathy B. Iyer MD, Abstract Co-Author: Nothing to Disclose

Richard Barakat MD, Abstract Co-Author: Nothing to Disclose

Dennis Chi MD, Abstract Co-Author: Nothing to Disclose

To correlate early postoperative CT findings with the surgeon’s assessment of residual disease in patients with advanced ovarian, tubal, and peritoneal carcinoma after optimal primary cytoreduction, and to determine the prognostic value of residual disease (RD) greater than 1 cm on early postoperative CT.

Our cohort was selected from an IRB-approved two-institution prospective study of patients who underwent primary cytoreductive surgery for presumed advanced ovarian cancer (January 2001 to September 2006); for 63 patients, the surgeon’s intraoperative assessment was consistent with optimal primary cytoreduction (i.e., RD 1 cm or less) and both preoperative and postoperative CTs were available. Preoperative and postoperative CTs from these patients were independently and retrospectively analyzed by two radiologists using a qualitative analysis (QA) scale from 1 (normal) to 5 (definitely malignant). Any lesion greater than 1 cm and with a QA score of 4 or 5 was considered RD on CT.

RD was detected on postoperative CT in 27 (43%) patients by reader 1 and 26 (42%) patients by reader 2, with residual tumor size ranging from 1.1 to 5.8 cm for both. Kappa statistic indicating interobserver agreement between two readers was 0.38. Based on reader 1’s assessment, the patients with RD on CT had worse overall survival (p=0.015) and disease-free survival (p=0.011); furthermore, the number and location of RD predicted overall survival (HR: 1.17, 95%CI: 1.01-1.35, p=0.042) and disease-free survival (HR: 1.15, 95%CI: 1.01-1.32, p=0.034). The integrated results from reader 2 were not associated with survival outcomes.

Differentiation between optimal and suboptimal primary cytoreduction has both management and prognostic significance. Currently, RD status is based primarily on the surgeon’s intraoperative assessment. In this study, early postoperative CT showed RD greater than 1 cm in 42% to 43% of patients deemed optimally debulked by the surgeon. In addition, for one of the two readers presence of RD on CT was associated with worse overall and disease-free survival.

This study suggests that early postoperative CT reveals RD in a substantial number of patients deemed optimally debulked at primary cytoreduction, and it provides important prognostic information.

Lakhman, Y, Hricak, H, Akin, O, Pannu, H, Sohn, M, Zheng, J, Moskowitz, C, Iyer, R, Barakat, R, Chi, D, Early Postoperative CT Reveals Residual Disease and Provides Prognostic Information in Patients with Advanced Ovarian, Tubal, and Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003626.html