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

• Published in: Gynecologic oncology Vol. 149; no. 3; pp. 525 - 530
• Main Authors: Eskander, Ramez N., Kauderer, James, Tewari, Krishnansu S., Mannel, Robert S., Bristow, Robert E., O'Malley, David M., Rubin, Stephen C., Glaser, Gretchen E., Hamilton, Chad A., Fujiwara, Keiichi, Huh, Warner K., Ueland, Frederick, Stephan, Jean-Marie, Burger, Robert A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2018
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab - therapeutic use; Carboplatin - administration & dosage; Carcinoma, Ovarian Epithelial; Cytoreduction Surgical Procedures - methods; Female; GOG; Hematology, Oncology, and Palliative Medicine; 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; NRG; Obstetrics and Gynecology; Ovarian cancer; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - diagnostic imaging; Ovarian Neoplasms - pathology; Ovarian Neoplasms - therapy; Paclitaxel - administration & dosage; Radiographic evaluation; Surgeon's assessment; Surgical cytoreduction; Young Adult; Radiographic evaluation; NRG; Surgical cytoreduction; Surgeon's assessment; GOG; Ovarian cancer
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2018.03.043

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. 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. 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). 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. •A 40% discordance was identified between surgeon and CT imaging with respect to residual disease.•The most frequently identified areas of discordance include the retroperitoneum and upper abdomen.•Objective measures of residual disease volume should be explored.