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Preop CT Identifies Unresectable Recurrent Ovarian Cancer

Preop CT Identifies Unresectable Recurrent Ovarian Cancer

CHICAGO—Preoperative helical computed tomography (CT) can improve the
management of women with recurrent ovarian cancer by identifying disease that
cannot be resected in secondary cytoreductive surgery, said Stacey A. Funt, MD,
assistant attending radiologist, Memorial Sloan-Kettering Cancer Center.

On the basis of findings from a study presented at the 87th Annual Meeting
of the Radiological Society of North America (RSNA abstract 770), Dr. Funt
concluded that in recurrent ovarian cancer, the bulk of unresectable tumor
burden occurs in the pelvis.

"All patients with retroperitoneal lymphadenopathy above the renal
hilum;
liver metastases; or tumor in the gallbladder fossa, falciform ligament,
gastrohepatic ligament, or gastrosplenic ligaments were nonresectable,"
she said. "Hydronephrosis, pelvic sidewall invasion, large bowel
obstruction, ascites, and peritoneal carcinomatosis were strong predictors of
tumor nonresectability."

Retrospective Review

Dr. Funt and her colleagues retrospectively reviewed preoperative CT
examinations that had been performed between 1996 and 2001 in 50 women who had
cytoreductive surgery for recurrent ovarian cancer. From these CT studies, they
recorded the presence of specific findings from the abdomen and pelvis.

Of the 50 patients, 24 had successful cytoreductive surgery. Secondary
cytore-duction was optimal when the diameter of residual cancer was less than 1
cm. Twenty-six women had disease that was considered to be nonresectable, and
three of these women were suitable only for palliative measures.

In 36 women (72%), predominant recurrent disease was found in the pelvis.
"Pelvic masses were found more often in patients who were nonresectable,
and the presence of a pelvic mass was a significant predictor of suboptimal
resection," she said.

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