Abstract:The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
“…They have become more accessible since development of GCIG criteria and RECIST and used in clinical practice but not routinely adopted in clinical trials. 18 F-FDG PET/CT has been shown to be more sensitive and specific when compared with CT scans, 91% versus 84% and 91% versus 65% [ 22 ], respectively. Early detection of PD with 18 F-FDG PET/CT is particularly important for consideration of SCR, since recent studies have reported improved survival when complete resection could be achieved [ 23 , 24 ].…”
Background
CA-125 alone is widely used to diagnose progressive disease (PD) in platinum-sensitive recurrent ovarian cancer (PSROC) on chemotherapy. However, there are increasing concerns regarding its accuracy. We assessed concordance between progression defined by CA-125 and RECIST using data from the CALYPSO trial.
Methods
We computed concordance rates for PD by CA-125 and RECIST to determine the positive (PPV) and negative predictive values (NPV).
Results
Of 769 (79%) evaluable participants, 387 had CA-125 PD, where only 276 had concordant RECIST PD (PPV 71%, 95% CI 67–76%). For 382 without CA-125 PD, 255 had RECIST PD but 127 did not (NPV 33%, 95% CI 29–38). There were significant differences in NPV according to baseline CA-125 (≤100 vs >100: 42% vs 25%, P < 0.001); non-measurable vs measurable disease (51% vs 26%, P < 0.001); and platinum-free-interval (>12 vs 6–12 months: 41% vs 14%, P < 0.001). We observed falling CA-125 levels in 78% of patients with RECIST PD and CA-125 non-PD.
Conclusion
Approximately 2 in 3 women with PSROC have RECIST PD but not CA-125 PD by GCIG criteria. Monitoring CA-125 levels alone is not reliable for detecting PD. Further research is required to investigate the survival impact of local therapy in radiological detected early asymptomatic PD.
“…They have become more accessible since development of GCIG criteria and RECIST and used in clinical practice but not routinely adopted in clinical trials. 18 F-FDG PET/CT has been shown to be more sensitive and specific when compared with CT scans, 91% versus 84% and 91% versus 65% [ 22 ], respectively. Early detection of PD with 18 F-FDG PET/CT is particularly important for consideration of SCR, since recent studies have reported improved survival when complete resection could be achieved [ 23 , 24 ].…”
Background
CA-125 alone is widely used to diagnose progressive disease (PD) in platinum-sensitive recurrent ovarian cancer (PSROC) on chemotherapy. However, there are increasing concerns regarding its accuracy. We assessed concordance between progression defined by CA-125 and RECIST using data from the CALYPSO trial.
Methods
We computed concordance rates for PD by CA-125 and RECIST to determine the positive (PPV) and negative predictive values (NPV).
Results
Of 769 (79%) evaluable participants, 387 had CA-125 PD, where only 276 had concordant RECIST PD (PPV 71%, 95% CI 67–76%). For 382 without CA-125 PD, 255 had RECIST PD but 127 did not (NPV 33%, 95% CI 29–38). There were significant differences in NPV according to baseline CA-125 (≤100 vs >100: 42% vs 25%, P < 0.001); non-measurable vs measurable disease (51% vs 26%, P < 0.001); and platinum-free-interval (>12 vs 6–12 months: 41% vs 14%, P < 0.001). We observed falling CA-125 levels in 78% of patients with RECIST PD and CA-125 non-PD.
Conclusion
Approximately 2 in 3 women with PSROC have RECIST PD but not CA-125 PD by GCIG criteria. Monitoring CA-125 levels alone is not reliable for detecting PD. Further research is required to investigate the survival impact of local therapy in radiological detected early asymptomatic PD.
“…PET/CT imaging with 18 F-FDG has a very high sensitivity rate of 85-100% for detection of recurrence in ovarian cancer (Figure 3), compared to CECT 18 F-FDG is more sensitive and more specific; with a sensitivity 91% vs. 84% for CECT and specificity of 91% vs. 65% (35).…”
Ovarian carcinoma remains an important cause of mortality and morbidity, which tends to be diagnosed at an advanced stage due to the non-specific and generalized nature of the symptoms.In this chapter, we review the clinical significance of ovarian cancer, its current diagnosis and treatment and the evolving role of nuclear medicine in the early, non-invasive detection and further management of these patients. We also consider some of the current and future theranostic possibilities in the quest for targeted treatment with fewer systemic side effects.
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