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Predicting Complete Cytoreduction in Ovarian Cancer Patients by RECIST 1.1 Criteria Following Neoadjuvant Chemotherapy

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Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Background

Complete cytoreduction (CC) is one of the most important prognostic factors for epithelial ovarian cancer (EOC). Response to neoadjuvant chemotherapy (NACT) is potentially important to predict CC as well as counseling the patients. We aimed to study if RECIST 1.1 response predicts CC in EOC following NACT.

Materials and Methods

This prospective observational study included 59 patients of EOC planned for NACT followed by interval debulking surgery (IDS). Response to NACT was assessed by RECIST 1.1 criteria. The level of cytoreduction during IDS was correlated with the radiological response. A Chi-square test was used for the group comparison.

Results

Half (50%) of patients had an objective response to NACT. CC was feasible in a total of 35 (62.5%) patients. Both response and cytoreduction levels were independent of clinical parameters. We observed 100% CC rates in CR, 95.8% in PR, 50% in SD and 12.5% in PD categories. RECIST 1.1 response was found significantly (p < 0.01) associated with levels of cytoreduction. The sensitivity, specificity, positive predictive value and negative predictive value of RECIST to predict CC were 77.1%, 95.2%, 96.4% and 71.4%, respectively.

Conclusions

RECIST 1.1 predicts CC in responders (CR/PR) well. We suggest against denying surgery solely based on RECIST criteria in the SD or PD patients. Given its imprecision in these circumstances, patient characteristics such as performance status, perioperative risk and comorbidities should be taken into account. The role of newer antineoplastic agents, three-dimensional or functional imaging and diagnostic laparoscopy should be explored further for predicting CC.

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Acknowledgements

We would like to thank Institutional Ethics Committee for the approval and conduct of the study.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Surgical Oncology, King George’s Medical University, 3rd Floor, Shatabdi Building, Lucknow, Uttar Pradesh, 226003, India

    Shiv Rajan, Naseem Akhtar, Sameer Gupta & Vijay Kumar

  2. Department of Gynecology and Obstetrics, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Sonali Sharma

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  1. Shiv Rajan
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  2. Naseem Akhtar
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  4. Sameer Gupta
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Contributions

SR and NA contributed to conceptualization. SR, NA and SS contributed to literature search and statistical analysis. SR, NA, SS and VK contributed to clinical studies, acquired and analyzed data and reviewed the manuscript. SR, NA and VK prepared the manuscript. SR and SS edited the manuscript. NA and VK contributed to supervision. SG contributed to clinical studies

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Correspondence to Vijay Kumar.

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Conflict of interest

The authors have no conflict of interest to declare that are relevant to the content of this article.

Ethical Approval

All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All authors have approved this manuscript, and each one believes that it represents original honest work.

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Informed consent was obtained from all individual participants included in the study.

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Rajan, S., Akhtar, N., Sharma, S. et al. Predicting Complete Cytoreduction in Ovarian Cancer Patients by RECIST 1.1 Criteria Following Neoadjuvant Chemotherapy. Indian J Gynecol Oncolog 19, 81 (2021). https://doi.org/10.1007/s40944-021-00575-z

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