IS CT SCAN MONITORING USEFUL IN PATIENTS WITH EPITHELIAL OVARIAN-CANCER AND FOLLOW-UP NEGATIVE CA-125 SERUM LEVELS

We retrospectively reviewed our series of ovarian cancers to assess th e benefit of routine follow-up abdominal computer tomography (CT) scan s in asymptomatic patients with CA 125 levels <35 U/ml. A chart review was undertaken of all patients with a diagnosis of ovarian cancers tr eated and followed at the Institute of Obstetrics and Gynecology, Univ ersity of Ancona, from January 1986 to January 1994. In asymptomatic p atients, the routine follow-up consisted of physical examination and C A 125 serum level determination every three to four months for the fir st two years, and every six months thereafter for a minimum of 5 years . At each visit, a history and a bimanual vaginal examination were com pleted. The pelvic and abdomen CT scans were performed every six month s for the first year and then annually. Inclusion criteria were CA 125 levels >35 U/ml prior to surgery or initial chemotherapy, and complet e routine follow-up. Fifty-two patients (75%) satisfied the inclusion criteria. After surgery, 32 of the 52 CA 125 positive patients (61%) s howed a decrease in CA 125 levels; 10 other patients showed a negativi ty of CA 125 after cisplatinum polychemotherapy. After a median time o f 49 months (range 16-117 months), 9 of the 42 patients (21%) develope d a relapse. The overall CA 125 sensitivity at the time of relapse was 78%, with a specificity of 94%; the sensitivity for early detection o f relapses was 70%. Two-hundred and seventy-six abdominal and pelvic C T scans were performed and 8 were positive for tumor relapse, with an overall sensitivity of 89%. The sensitivity of CT scans was 33% for ea rly detection of relapses. The routine performance of follow-up CT sca ns did not significantly improve the overall detection of early relaps es in ovarian carcinoma. A longitudinal monitoring of serum CA 125 is a reliable method of follow-up. Abdominal and pelvic CT scans should b e performed in patients who, after a period in which they have been cl assified as not having evidence of disease with normal CA 125 serum le vels, show elevated and rising CA 125, with the aim of finding and cha racterizing relapses.