abstract: Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Monday, February 13, 2012

abstract: Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy




Objective

To evaluate the predictive power of serum CA-125 changes in the management of patients under going neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC).

Methods

Using the Cancer Registry databases from our institutions, a retrospective review of patients with FIGO stage IIIC and IV EOC who were treated with platinum-based NACT-IDS between January 2006 and December 2009 was conducted. Demographic data, CA-125 levels, radiographic data, chemotherapy, and surgical-pathologic information were obtained.

Results

One hundred-three patients with stage IIIC or IV EOC met study criteria. Median number of neoadjuvant cycles was 3. Ninety-nine patients (96.1%) were optimally cytoreduced. Forty-seven patients (47.5%) had resection to no residual disease (NRD). The median CA-125 at diagnosis and before interval debulking was 1749 U/mL and 161 U/mL, respectively.

Comparing patients with NRD (no residual disease)  v. optimal macroscopic disease (OMD), there was no statistical difference in the mean CA-125 at diagnosis (1566 U/mL v. 2077 U/mL, p = 0.1).

There was a significant difference in the mean CA-125 prior to interval debulking, 92 v. 233 U/mL (p = 0.001).

In the NRD group, 38 patients (80%) had preoperative CA-125 ≤ 100 U/mL compared to 33 patients (63.4%) in the OMD group (p = 0.04).

Conclusions

 Patients who undergo NACT-IDS (neoadjuvant chemotherapy followed by interval debulking surgery) achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤ 100 U/mL were highly likely to be cytoreduced to no residual disease.

Highlights

► Patients with advanced ovarian cancer treated with neoadjuvant chemotherapy have high rates of optimal cytoreduction.
► Preoperative CA-125 < 100 may indicate a high probability of debulking to no gross residual disease.
► A drop of > 80% in CA-125 during neoadjuvant treatment may suggest platinum sensitive disease.

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