Positron emission tomography in the management of documented or suspected recurrent ovarian cancer

Objectives To prospectively evaluate the value of positron emission tomography (PET) or integrated computed tomography (CT) and PET (PET/CT) in the management of documented or suspected recurrent ovarian cancer

Methods Patients with ovarian cancer who had completed primary cytoreductive surgery and standard adjuvant chemotherapy were enrolled to evaluate the following indications: (1) CA-125 elevation after complete remission with negative CT or magnetic resonance imaging (MRI) (CT/MRI); (2) post-therapy surveillance CT/MRI-detected suspicious lesions that guided biopsy was not feasible; (3) documented relapse for restaging before or after curative salvage therapy. The clinical impact of PET, as compared with those of CT/MRI, was determined on a per scan basis. The gold standard was based on the pathology, serum CA-125 level and/or follow-up imaging.

Results From January 2002 to Oct 2009, 73 patients were recruited, and 92 PET scans were performed. Up to June 2015, 53 patients had died of disease, 4 were alive with disease, and the remaining 16 were alive without disease (4 were disease-free throughout, 12 were successfully salvaged). Among the 92 scans, PET had positive impacts in 72.8%, no clinical impacts in 21.7% and negative impacts in 5.4%. For unexplained CA-125 elevation after complete remission, the sensitivity and positive predictive value of PET in detecting recurrence were 80.0% and 92.3%. For post-therapy surveillance CT or MRI-detected suspicious lesions that guided biopsy was not feasible, the sensitivity, specificity, positive predictive value and negative predictive value of PET were 91.2%, 62.5%, 91.2%, and 62.5%, respectively.

Conclusions PET has value in the management of suspected or documented recurrent ovarian cancer, with positive impacts on confirming recurrent status and offering a better treatment plan.