The Clinical Impact of Computed Tomography Immediately Following Primary Chemotherapy in Patients With Epithelial Ovarian Cancer

Abstract

Purpose: The National Comprehensive Cancer Network recommends computerized tomography (CT) for monitoring patients with epithelial ovarian cancer (EOC) as clinically indicated. We sought to evaluate the impact of the initial post-treatment CT scan on subsequent therapy in patients with EOC. Patients and Methods: We retrospectively identified patients diagnosed with EOC between January 2000 and December 2007. Eligible patients underwent debulking or staging and received postoperative chemotherapy. Following chemotherapy, disease status was assessed using physical examination, measurement of carcinoma antigen (CA)-125 levels, and CT scan of the abdomen and pelvis. The Student t test and χ2 test were used to determine statistical significance. Results: A total of 187 patients had a complete clinical response to primary chemotherapy as determined by normal physical exam and CA-125 levels. Of this cohort, 127 patients (68%) had a normal CT, 51 patients (27%) had an equivocal CT, and 9 patients (5%) had an abnormal CT. Of the 51 patients with an equivocal CT, 11 had a positron emission tomography scan or repeat CT scan performed; however, no patient received immediate surgery or chemotherapy. Fifty-seven percent of the patients with a normal post-treatment CT compared with 72% of the patients with an equivocal CT experienced a recurrence (P = .07). Patients with normal and equivocal CT scans had similar median times to recurrence, 12.2 months versus 12.6 months, respectively. Conclusion: Immediately following completion of primary chemotherapy, few patients with a complete clinical response will have an abnormal CT scan. Although a significant number of patients will have an equivocal CT scan, it is rare that this finding alters the clinical management of patients with EOC. Although CT scans are useful as a baseline for future imaging studies, they seldom change management in this patient population.