Impact of FDG PET/CT on the management of patients with suspected recurrent ovarian carcinoma: A prospective, multi-centre study as part of the Australian PET Data Collection Project

Abstract

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Objectives: To: a) assess the impact of FDG PET/CT on the management of patients with suspected recurrent ovarian cancer and, b) determine the incremental information provided by PET/CT in this context. Methods: Ninety women (mean age 59.9 yrs; age range 35-85 yrs) with a previous history of treated epithelial ovarian carcinoma and suspected recurrence based on elevated CA-125, anatomical imaging or clinical symptoms were studied with FDG PET/CT across three States. Referring doctors were asked to specify: i) a management plan pre-PET, ii) if management was altered after PET/CT and, iii) the impact (rated - none, low, medium, high; where none indicated PET data were ignored, low where treatment modality was unchanged, medium where planned procedure / dose or mode of therapy was altered and high where treatment modality changed) of PET/CT on patient management. The pre-PET management plan could include radiotherapy, chemotherapy, surgery, and other including observation. Patients were followed at 6 and 12 months post-PET/CT scan and clinical status, evidence of recurrence and progression were recorded. Results: Patients were referred by 34 individual specialists. At least 168 additional sites of disease in 61 patients (68%), not identified by conventional imaging were identified by PET/CT. In 77% of these the additional lesions were located below the diaphragm and most were nodal or peritoneal. PET/CT affected management in 60%; 49% with high and 11% with medium impact. Patients where more disease was detected with PET/CT were more likely to progress in the following 12 mths. Conclusions: In this project PET/CT: a) altered management in 60% of women with suspected recurrent ovarian carcinoma, b) detected more sites of disease and was superior to abdominal and pelvic CT in the detection of nodal, peritoneal and subcapsular liver disease, c) offered the opportunity for technology replacement and, d) is the preferred imaging technique in this setting.

Research Support (if any): Commonwealth of Australia via Medicare reimbursement and provision of data manager