The Efficiency of CT at Pre-Operative Evaluation Stage of PCI in Patients with Recurrent Ovarian Cancer

Abstract

The CT imaging of abdomen and pelvic region with contrast enhancement using one slice spiral computed tomography Somatom Emotion (Siemens, Germany) was performed. The retrospective analysis of the results of pre-operative CT in 32 patients with advanced ovarian cancer and peritoneal canceromatosis was carried out/implemented. Within this population the average age was 53,2±6years. Out of the 32 patients, 7 had stage FIGO II, 24 had stage FIGO III and 1 had stage FIGO IV. Due to the histological subtypes the ovarian cancer had the following distribution: serous papillary carcinoma in 27(24,4%), clear cell in 1(3,1%), papillary carcinoma in 1(3,1%) and mucinous adenocarcinoma in 3(9,4%) patients. Cytoreductive therapy for all patients was held. Thus, six cycles of chemotherapy protocol CP (cyclophosphamide 750mg/m 2 and cisplatin 75mg/m2) or PC (paclitaxel 175mg/m and carboplatin auc 5) were held. 8 patients underwent neoadjuvant chemotherapy (3 cycles CP), cytoreductive surgical therapy with further adjuvant chemotherapy. 17 patients showed disease progression in more than 12months (clinically sensitive to platinum derivatives). In 8 patients disease progression less than a year after the end of treatment was diagnosed. 25 patients underwent surgical treatment of recurrent tumor with following chemotherapy using platinum derivatives if sensitivity to the drug was present. In case of moderate sensitivity to platinum derivatives after surgical treatment the chemotherapy of 2 nd line was applied. While planning primary and repetitive cytoreductive therapy CT of the abdomen and pelvis using one slice spiral CT «Somatom Emotion» («Siemens», Germany) with spiral type scan axial plane was performed. 5-10 Technical parameters of the scan were: voltage -130kV, current -11mA, spiral step-3.0-5.0mm, tube rotation time -1.0sec. Intravenous and oral contrast enhancement to improve visualization of the pathological process was performed. For intravenous contrast enhancement water-soluble low osmolarity radiocontrast agent (iohexol, iopromide) with the calculation of 1.4ml per kg body weight of the patient was used. Gastrointestinal tract was filled with water-soluble high ocmolarity radiocontrast agents or other negative (water) solutions. While detecting of peritoneal carcinomatosis implants location and size of the latter were evaluated. After CT was performed all patients were operated. The average time between CT and surgery was 17days. The true data of the distribution and the implants' size were received during the surgical revision of the abdomen and pelvis, which was in detail recorded during the surgery. Comparing the CT results with the data of intraoperative revision, the P. Sugarbaker's classification of peritoneal carcinomatosis index (PCI) was used.11 According to the latter abdomen is divided conditionally with two horizontal and two vertical lines into nine quadrants, small intestine -along into four parts (proximal and distal parts of jejunum and ileum), in total 13 sites. In each area the size of the largest ...