CHICAGOPreoperative 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."
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.