title: Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To evaluate the predictive power of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC).
  
  
  METHODS
  Using the Cancer Registry databases from our institutions, a retrospective review of patients with FIGO stage IIIC and IV EOC who were treated with platinum-based NACT-IDS between January 2006 and December 2009 was conducted. Demographic data, CA-125 levels, radiographic data, chemotherapy, and surgical-pathologic information were obtained. Continuous variables were evaluated by Student's t test or Wilcoxon-Mann-Whitney test.
  
  
  RESULTS
  One hundred-three patients with stage IIIC or IV EOC met study criteria. Median number of neoadjuvant cycles was 3. Ninety-nine patients (96.1%) were optimally cytoreduced. Forty-seven patients (47.5%) had resection to no residual disease (NRD). The median CA-125 at diagnosis and before interval debulking was 1749U/mL and 161U/mL, respectively. Comparing patients with NRD v. optimal macroscopic disease (OMD), there was no statistical difference in the mean CA-125 at diagnosis (1566U/mL v. 2077U/mL, p=0.1). There was a significant difference in the mean CA-125 prior to interval debulking, 92 v. 233U/mL (p=0.001). In the NRD group, 38 patients (80%) had preoperative CA-125≤100U/mL compared to 33 patients (63.4%) in the OMD group (p=0.04).
  
  
  CONCLUSIONS
  Patients who undergo NACT-IDS achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤100U/mL were highly likely to be cytoreduced to no residual disease.
authors.affiliation: Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Rodriguez
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Melina
authors.initials: M
authors.lastname: Shoni
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
authors.forename: Michael G
authors.initials: MG
authors.lastname: Muto
authors.forename: Colleen
authors.initials: C
authors.lastname: Feltmate
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Del Carmen
authors.forename: Ursula A
authors.initials: UA
authors.lastname: Matulonis
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D018394:CA-125 Antigen / Q000097:blood*; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000097:blood / Q000473:pathology; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D001952:Bridged-Ring Compounds; D018394:CA-125 Antigen; D009944:Organoplatinum Compounds; D043823:Taxoids; C080625:taxane