CA125 Value As an Indicator for Imaging for Detection of CA Ovary Recurrence After Primary Treatment

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Background: GCIG states that CA125 value double of upper limit of normal during follow-up after primary treatment is a criteria for further intervention. However, in our institution we found that significant number of women with a CA 125 > 35 u/mL have recurrent disease on imaging. Aim: To compare values of CA125 rise as an indicator for imaging for detection of recurrence after primary treatment. Methods: It was retrospective observational study. 64 women with stage III and IV epithelial ovarian cancer who had normal CA125 on completion of primary therapy from January 2012 to December 2016 at Tata Medical Center, Kolkata, India were included in the study. These women were followed up with Ca125 three monthly for 2 years then six monthly. CA 125 doubling from posttreatment baseline or exceeding 35 u/mL were investigated with CT imaging. Data were collected from hospital management system electronic medical records. Results: Out of 146 patients who underwent IDS 64 (43.8%) had normal CA125 post treatment. 2 patients with doubling of Ca125 but < 35 u/mL had recurrence, all of whom had R0 during IDS. 1 patient with normal CA 125 had clinical recurrence and this patient had R2 disease during IDS. 2 patients with normal CA 125 had recurrence on radiology only and they had R0 during IDS. 18 (24%) had radiologic recurrence when CA125 was > 35 u/mL out of which14 patients had R0 and 4 patients R1 disease during IDS. 41 patients had recurrence detected on radiology when CA125 was > 70 u/mL. Out of these 27 had R0, 11 patients had R1 and 3 patients had R2 disease on IDS. 78% of R0 patients had disease recurrence when CA125 was > 35 u/mL. Conclusion: Imaging should be considered when CA125 rises > 35u/mL, rather than waiting for it to double the upper limit of normal, so that early detection of recurrence can initiate timely treatment. Rise of CA125 above 35 u/mL is a good criteria for imaging to detect recurrence even in women with R0 resection. CA125 can be used as a good tool for follow-up especially in low resource setting where people cannot afford routine imaging.