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.

The size of the lesions was not an important indicator of surgical success, however. "Lesions in the suboptimally resected group tended to be larger, but the difference was not statistically significant," Dr. Funt said.

Invasion of adjacent organs may indicate nonresectability, she noted. Pelvic sidewall invasion is the most telling indicator, with a positive predictive value (PPV) of 85%.

Two of 13 women had optimal resection despite pelvic sidewall invasion. However, Dr. Funt said, both of the women required aggressive surgery. In one case, the surgeon had to resect the pyriformis muscle in order to remove a mass in the pelvic sidewall. The pathology report also noted bone scrapings from the sacrum.

Large Bowel Obstruction

Large bowel obstruction also was a strong indicator of nonresectability, with a PPV of 89%. Small bowel obstruction was not as strong of a predictor, with a PPV of 64%. Ascites and hydronephrosis were found in 34% of patients with recurrent ovarian cancer, but hydronephrosis had a higher PPV for nonresectability (94%).

"In patients considered for secondary cytoreductive surgery, preoperative CT can impact future management by predicting nonresectable disease. Prospective studies are needed," Dr. Funt concluded.