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
| Autor: | Jean-Marie Stephan, Ramez N. Eskander, Robert E. Bristow, Chad A. Hamilton, Frederick R. Ueland, Krishnansu S. Tewari, Stephen C. Rubin, Keiichi Fujiwara, Gretchen E. Glaser, James Kauderer, David M. O'Malley, Robert S. Mannel, Warner K. Huh, Robert A. Burger |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Neoplasm Residual Paclitaxel Bevacizumab Concordance Gynecologic oncology Carcinoma Ovarian Epithelial Article Carboplatin law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Maintenance therapy law Antineoplastic Combined Chemotherapy Protocols medicine Humans Neoplasms Glandular and Epithelial 030212 general & internal medicine Young adult Aged Neoplasm Staging Aged 80 and over Ovarian Neoplasms business.industry Obstetrics and Gynecology Cytoreduction Surgical Procedures Middle Aged medicine.disease medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Abdomen Female Radiology Neoplasm Grading Ovarian cancer business medicine.drug |
| Zdroj: | Gynecol Oncol |
| ISSN: | 0090-8258 |
| DOI: | 10.1016/j.ygyno.2018.03.043 |
| Popis: | 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 1,873 enrolled patients, surgical outcome was described as optimal (RD ≤ 1 cm) 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 26 days (range: 1–109). In 251 cases (40%), the post-operative scan was discordant with surgeon assessment, demonstrating RD > 1 cm in size. RD > 1 cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal para-aortic lymph nodes (RD > 1.5 cm; 28.2%) and the left upper quadrant (10.7%). Patients with RD > 1 cm 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 > 1 cm 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. |
| Databáze: | OpenAIRE |
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