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The Value of Postoperative/Preadjuvant Chemotherapy Computed Tomography in the Management of Patients With Ovarian Cancer
  1. Evis Sala, MD, PhD, FRCR*,
  2. Lorenzo Mannelli, MD*,
  3. Kenji Yamamoto, MB, BS, BSc*,
  4. Michelle Griffin, MB, BChir,
  5. Nyree Griffin, MD, FRCR*,
  6. Lee Grant, MB, ChB, BA, MRCS, FRCR*,
  7. Richard Parker, PhD and
  8. Robin Crawford, MD, FRCS, FRCOG
  1. * Departments of Radiology and
  2. Gynaecological Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust; and
  3. Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  1. Address correspondence and reprint requests to Evis Sala, MD, PhD, FRCR, University Department of Radiology, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom. E-mail: es220{at}


Objective: The objectives of the study were to compare the operative assessment of residual disease with the postoperative computed tomography (CT) findings in patients with ovarian cancer who underwent primary surgical cytoreduction or interval debulking surgery to residual disease 1 cm or less and to assess the effect of potential prognostic factors on patient survival.

Methods: Patients scheduled for surgery and with an available postoperative CT were eligible for the study. Images were retrospectively analyzed in consensus by 2 radiologists. A 5-point qualitative scoring system was used to evaluate the CT findings (1 = tumor definitely absent, 2 = tumor probably absent, 3 = tumor possibly present, 4 = tumor probably present, 5 = tumor definitely present).

Results: Between September 2005 and December 2008, 206 consecutive patients were enrolled; 51 were eligible. In 30 cases (59%), the postoperative CT findings correlated with the surgeon's assessment of residual disease. For the univariate analyses, the only significant prognostic factors associated with overall survival were no residual disease versus residual disease of less than 1 cm as assessed by the surgeon (hazard ratio [HR], 3.06; 95% confidence interval [CI], 1.29-7.27; P = 0.011) and no residual disease versus residual disease greater than 1 cm on CT (HR, 2.57; 95% CI, 1.02-6.48; P = 0.045). The interaction of surgical residual disease and stage 3 was significant (HR, 3.40; 95% CI, 1.42-8.16; P = 0.006) in the multivariate Cox model.

Conclusions: There was only 59% correlation between the surgical assessment and postoperative CT findings of residual disease in patients reported to have undergone optimal surgery. Stage and residual disease as assessed by the surgeon were significant prognostic factors for overall survival. The value for postoperative CT may lie in those cases with small-volume residual disease (visible but reported as <1 cm) at surgery.

  • Ovarian cancer
  • Computed tomography
  • Postoperative assessment
  • Residual disease
  • Survival

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