Abstract
Rationale and objectivesTo evaluate the impact of metabolic parameters in the peritoneal cavity on the likelihood of achieving complete tumor debulking in patients with ovarian and peritoneal cancers.Materials and methodsForty-nine patients with ovarian and peritoneal cancers were included, who underwent pre-operative 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT). The immediate surgical outcome was dichotomized into complete and incomplete tumor debulking. 18F-FDG PET/CT was qualitatively and quantitatively assessed by scrutinizing 15 anatomical sites for the presence of peritoneal carcinomatosis (PC). Patient-based and site-based diagnostic characteristics were described. Metabolic parameters (SUVmax, metabolic tumor volume and total lesion glycolysis) and the number of 18F-FDG avid peritoneal sites were evaluated between the two groups. Receiver operating curve (ROC) analysis was performed to determine the optimal cut-off value in predicting incomplete tumor debulking.ResultsTwenty-seven out of the 49 patients had PC and 11 had incomplete debulking. Patient-based and site-based accuracies for detection of PC were 87.8 and 97.6%, respectively. The number of 18F-FDG avid peritoneal sites was significantly different between complete and incomplete debulking groups (0.6 ± 0.8 versus 2.3 ± 1.7 sites respectively, p = 0.001), and the only independent significant risk factor among other metabolic parameters tested (odd ratio = 2.983, 95% CI 1.104–8.062) for incomplete tumor debulking with an optimal cut-off value of ≥4 (AUC = 0.816).ConclusionThe number of 18F-FDG avid peritoneal sites increased the risk of incomplete tumor debulking after surgery and potentially useful in assisting treatment stratification in patients with ovarian and peritoneal cancers.
Highlights
Clinical symptoms of ovarian and peritoneal cancers are not apparent until the diseases reach advanced stages and hamper early detection [1]
The number of 18F-FDG avid peritoneal sites was significantly different between complete and incomplete debulking groups (0.6 ± 0.8 versus 2.3 ± 1.7 sites respectively, p = 0.001), and the only independent significant risk factor among other metabolic parameters tested for incomplete tumor debulking with an optimal cut-off value of ≥4 (AUC = 0.816)
The number of 18F-FDG avid peritoneal sites increased the risk of incomplete tumor debulking after surgery and potentially useful in assisting treatment stratification in patients with ovarian and peritoneal cancers
Summary
Clinical symptoms of ovarian and peritoneal cancers are not apparent until the diseases reach advanced stages and hamper early detection [1]. The survival rate of patients with early stage disease is favorable at approximately 90%; most cases present late when symptoms become significant [2] with survival dropping to 20 to 30% in Upfront debulking surgery (UDS) followed by chemotherapy is the standard treatment for ovarian and peritoneal cancers. UDS aims at achieving complete tumor debulking in order to be left with no residual disease as this has the most impact on survival outcome [3]. Sometimes, this will require ultra-radical surgical procedures that include maximal stripping of diseased peritoneum and resection of multiple visceral organs to achieve this [1]. PC is a negative predictor of achieving complete tumor debulking, in which the success rate decreased significantly to 26% compared to 76% in patients without PC [5]
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