Introduction/Background*Complete tumor resection (R0) at primary or interval debulking surgery is a main prognostic factor for overall survival in patients diagnosed with ovarian cancer. Neoadjuvant treatment has become standard of care in patients with advanced disease (FIGO stage IIIC/IV) or reduced performance status. Radiologic assessment of treatment response using CT scans has a low prediction for complete surgical tumor resection.
Here we aim to identify prognostic factors associated with R0-resection after neoadjuvant chemotherapy (NACT) for ovarian cancer and propose a multimodal scoring system using 3 Tesla diffusion-weighted MRI (DW-MRI), CA-125 and diagnostic laparoscopy for future investigation.
Methodology All patients treated with neoadjuvant chemotherapy for advanced primary ovarian, peritoneal or Fallopian tube cancer between 01/2012-12/2020 at the University Hospital Bern were included in this retrospective cohort study. Clinical and surgical data assessed include age, menopausal status, ECOG performance status, radiologic findings, histologic subtype, FIGO stage, CA-125, Fagotti-score, surgical resection status and chemotherapeutic regimen.
Multiple MR-graphic findings are scored number and distribution of intra-abdominal and thoracal lesions, qualitative and quantitative diffusion restriction, lymph nodal (LN) status, as well as prevalence and size of cardio-phrenic LN. Following treatment, change in tumor and metastatic lesion size are assessed.
Result(s)*Overall, 130 out of 475 women with primary ovarian cancer treated at the University Hospital Bern between 2012 – 2020 underwent NACT. Mean age was 66.2 years (range 24-90). Most patients were diagnosed with high-grade serous subtype (92%) at FIGO stage IIIC or IV (78%). Interval debulking surgery was performed and resection status was noted for 112 patients after a mean of 3 neoadjuvant cycles. R0 resection was achieved in 80 patients (71.4%), 10 patients (8.9%) had residual disease <1cm.
Until now, in our cohort, DW-MRI was performed in three patients during NACT.
Conclusion*We propose a multimodal scoring system for R0-resection based on DW-MRI, CA-125 and Fagotti-Score assessed during diagnostic laparoscopy. To validate this score, a prospective multicentre study including women with suspected primary or recurrent ovarian cancer is planned.
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