What do patients think about CA-125 monitoring in the follow-up? Results from a multicenter trial in 1,060 patients with ovarian cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5522-5522
Author(s):  
G. Oskay-Oezcelik ◽  
A. du Bois ◽  
P. A. Fasching ◽  
S. Mahner ◽  
C. Liebrich ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Care ◽  
Clinical Symptoms ◽  
Survey Methods ◽  
Multicenter Trial ◽  
Ca 125 ◽  
Primary Ovarian Cancer ◽  
Primary Surgery ◽  
Physician Patient

5522 Background: In the clinical day CA-125 monitoring is frequently used as a part of follow-up care for patients with ovarian cancer (OC). However, the potential benefit of CA-125 controls in the absence clinical symptoms are still unclear.There is little known about the expectations and preferences of patients with OC. Therefore we have initiated a multi-institutional survey. Methods: A semi-structered consisting 15 questions was developed in a pilot-study of 20 patients. After this validation all gynecological departments and gynecological-oncological practices were invited to participate in this trial using an anonynomous print version of the questionaire Results: Between December 2006 and December 2007 a total of 1,060 patients were enrolled. The median age of the patients was 58 years (range 16–87). 60% of the patients had primary ovarian cancer, 40% had relapsed ovarian cancer. Routine follow-up visits were mostly performed by gynaecologists in a gynaecological practice (56.9%) and in hospitals (49.5%). Patients were informed about the procedures and goals of cancer care predominantly after primary surgery (62.5%) and in 15.7% after last cycle of first-line chemotherapy. 7.7% declared that they were informed only at the first follow-up visit, 9.2% stated that they have never received any information about their cancer care management. According the patient´s opinion the main objective for the follow-up is the early detection of relapse and a prolongation of overall survival (95.8%). About more than 90% get CA-125 measurements. These were the procedures with highest anxiety but also the most important procedure for the patient. Finally, most patients (89%) were satisfied from their management of cancer care. Conclusions: The present study is the largest survey about cancer care so far and provides several important data for physician-patient communication concerning the follow-up management of patients OC. No significant financial relationships to disclose.

The second-look operation improves survival in suboptimally debulked stage III ovarian cancer patients

2005 ◽  
Vol 15 (1) ◽  
pp. 19-25 ◽  
Author(s):  
J. Rahaman ◽  
P. Dottino ◽  
T. S. Jennings ◽  
J. Holland ◽  
C. J. Cohen
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Stage Iii ◽  
Single Institution ◽  
Primary Ovarian Cancer ◽  
Primary Surgery ◽  
Second Look ◽  
Survival Difference ◽  
Second Look Operation

In a single-institution retrospective cohort study, 230 patients were treated for stage III primary ovarian cancer and 175 became eligible for second-look operations by virtue of a complete clinical response after primary surgical cytoreduction and platinum-based combination chemotherapy. Of these, 109 underwent a second-look operation. Optimal primary cytoreduction was defined as residual disease ≤1 cm. Median follow-up was 68.3 months. Five-year survival for all the 230 stage III ovarian cancers was 43.4%. Among all eligible patients (n = 175), there was no survival difference (P = 0.67) in those having second look (57.3%, 5-year survival) versus no second look (48.7%). In those patients with optimal primary cytoreduction (n = 118), there was no survival advantage to second look (69% versus 61%, P = 0.7). However, in those with suboptimal primary cytoreduction (n = 47), 5-year survival was 36% in those having second look versus only 13% in those refusing second look (P < 0.05). Multivariate analysis identified second-look surgery as the only significant independent prognostic variable affecting survival (RR = 0.321, P < 0.04). Patients with suboptimal debulking at primary surgery for stage III ovarian cancer appear to achieve a survival benefit from second-look surgical procedures, presumably from the early identification and treatment of residual disease.

ESGO Statement on the Role of CA‐125 Measurement in Follow-Up of Epithelial Ovarian Cancer

2012 ◽  
Vol 22 (1) ◽  
pp. 175-175 ◽  
Author(s):  
Nicoletta Colombo ◽  
Gerald Gitsch ◽  
Nicolas Reed ◽  
Frederic Amant ◽  
David Cibula ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Ca 125

Fifth Alon Dembo Memorial Workshop: Case 3

2010 ◽  
Vol 20 (Suppl 2) ◽  
pp. S24-S26 ◽  
Author(s):  
Peter E. Schwartz
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Cancer Patient ◽  
Recurrent Ovarian Cancer ◽  
Ca 125 ◽  
Advanced Stage ◽  
Recurrent Cancer ◽  
Treatment Regimens ◽  
Platinum Sensitive ◽  
Very High

Background:OVO5/EORTC 55855, a study punitively refuting the value of CA-125 in the follow-up of ovarian cancer patients, has many deficiencies, including a heterogeneous ovarian cancer patient population, no control of initial treatment regimens, and no control of subsequent surgery or chemotherapeutic management for recurrence. Recent studies suggest a role for prompt surgery in selected cases of recurrent ovarian cancer with CA-125 elevations, a role for tamoxifen in managing rising CA-125 levels in patients without evidence of disease and the use of platinum doublets for treating recurrent platinum-sensitive disease, none of which were incorporated into OVo5/EORTC 55955.Case:A patient with advanced stage ovarian cancer presenting with a CA-125 level of 2000 U/mL, who is initially treated with surgery followed by chemotherapy and has a normal CT scan and normal CA-125 at completion of her initial chemotherapy.Conclusion:This patient remains at a very high risk for recurrence. I would continue to monitor this patient with serial CA-125 levels to identify recurrent cancer and consider initiating treatment before it is clinically obvious.

The relevance of rising CA-125 levels within the normal range in predicting recurrence in patients with advanced stage ovarian cancer: A validation study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16521-e16521
Author(s):  
F. AbuShain ◽  
P. Escobar ◽  
S. Shahabi ◽  
C. Michener ◽  
R. Drake ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Stage Iv ◽  
Complete Response ◽  
Disease Recurrence ◽  
Ca 125 ◽  
Normal Range ◽  
Number Of Patients ◽  
Response To Chemotherapy ◽  
Significant Difference

e16521 Background: Small published series suggested that three progressively rising CA-125 values, doubling of CA-125, and an absolute rise of 5 U/mL from the nadir, all while remaining in the normal range were highly associated with disease recurrence. This study aims to validate these proposed criteria in a larger population. Methods: We conducted a retrospective review of the records of patients with stages IIIC and IV epithelial ovarian cancer treated with primary surgery and adjuvant chemotherapy between 1994 and 2006. Only patients who had a complete response to chemotherapy verified by normal CT scan, CA-125 and physical examination were included. Nadir CA-125 level was defined as the first CA-125 measurement after completing chemotherapy. Available CA-125 values from diagnosis to recurrence or to last follow up were collected and evaluated for meeting any of the criteria above. Results: 91 patients with a median age of 59 (42 - 88) met the inclusion criteria. 82 patients had stage IIIC (90%) and 9 patients (10%) had stage IV. 86 patients (94.5%) had papillary serous histology and 88 patients had grade 3 (96.7%) disease. Median follow up was 43.7 months (12.6 - 156). Table 1 shows the number of patients who met any of the above CA-125 criteria in total and divided by the presence or absence of recurrence. There was no statistically significant difference in meeting any of the CA-125 criteria between the recurrence and no recurrence groups. Meeting at least one of the CA-125 criteria had 50% sensitivity, 65% specificity, and 86% positive predictive value for recurrence. The median time to recurrence in patients who met at least one CA-125 criteria was 3.8 months (0.2 - 12.4) and the median follow up time after meeting one of the CA 125 criteria in patients who did not recur was 88.5 months (10.4 - 188) Conclusions: Rising CA-125 levels within the normal range that meet any of the above criteria are highly predictive (86%) of recurrence within 12 months and closer observation is warranted. [Table: see text] No significant financial relationships to disclose.

What Surveillance Plan Should Be Advised for Patients in Remission After Completion of First-Line Therapy for Advanced Ovarian Cancer?

2010 ◽  
Vol 20 (Suppl 2) ◽  
pp. S27-S28 ◽  
Author(s):  
Gordon J. S. Rustin
Keyword(s):  
Ovarian Cancer ◽  
Medical Research Council ◽  
Advanced Ovarian Cancer ◽  
Clinical Indication ◽  
Ca 125 ◽  
First Line ◽  
The Third ◽  
First Line Therapy ◽  
Line Therapy

Based on the results of the Medical Research Council OVO5/European Organisation for Research and Treatment of Cancer 55955 trial, the follow-up plan I recommend for patients in remission after completion of first-line therapy for advanced ovarian cancer is appointments: every 3 months for 2 years, every 4 months on the third year, then every 6 months thereafter, and discharge if no relapse by 10 years. History and examination (not internal) should be performed at each appointment. CA-125 should only be measured if there is a suspicion of relapse or at patient's request. No scans should be performed unless clinical indication or rising CA-125.

A Population-Based 5-Year Cohort Study Including All Cases of Epithelial Ovarian Cancer in Western Sweden: 10-Year Survival and Prognostic Factors

2009 ◽  
Vol 19 (1) ◽  
pp. 116-123 ◽  
Author(s):  
Margaretha Åkeson ◽  
Anne-Marie Jakobsen ◽  
Britt-Marie Zetterqvist ◽  
Erik Holmberg ◽  
Mats Brännström ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cohort Study ◽  
Prognostic Factors ◽  
Residual Tumor ◽  
Population Based ◽  
Ca 125 ◽  
Term Survival ◽  
Ploidy Status

Epithelial ovarian cancer (EOC) is the major gynecologic cancer mortality cause in Sweden. The aim of the present study was to investigate the long-term survival and prognostic factors of a complete population-based 5-year cohort of 682 patients with invasive EOC in western Sweden (population around 1.6 million). Data relating to residual tumor after surgery, FIGO stage, grade, histopathologic subtype, ploidy status, adjuvant chemotherapy (the prepaclitaxel period), and disease state (recurrence and death) were reported to a quality register in a prospectively kept database and were controlled against the Swedish National Cancer Registry for completeness. The median follow-up durations for the prospectively collected data in the Cox analysis and for the survival analysis that was made for all patients were 81 months (range, 52-109 months) and 11.7 years (range, 8.7-14.1 years), respectively. No patient was lost to follow-up. The relative 10-year survival rate was 38.4% (95% confidence interval, 34.5%-42.8%). The median relative survival time was 4.3 years (95% confidence interval, 3.6%-5.2%). In the univariate Cox regression analysis, prognostic significances for age, stage, residual tumor, histopathologic subtype of serous cystadenocarcinoma, grade, CA-125, and ploidy status were seen. In the multivariate analysis, age, stage, residual tumor after surgery, and postoperative CA-125 were of prognostic significance. In conclusion, 4 major prognostic factors were found for EOC in this population-based cohort study that also presents nearly accurate long-term survival owing to the nonselective nature and completeness regarding patients and follow-up of the study.

Risk of Epithelial Ovarian Cancer Recurrence in Patients With Rising Serum CA-125 Levels Within the Normal Range

2005 ◽  
Vol 23 (36) ◽  
pp. 9338-9343 ◽  
Author(s):  
Antonio Santillan ◽  
Ruchi Garg ◽  
Marianna L. Zahurak ◽  
Ginger J. Gardner ◽  
Robert L. Giuntoli ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Elevated Serum ◽  
Complete Response ◽  
Disease Recurrence ◽  
Ca 125 ◽  
Cancer Antigen 125 ◽  
Normal Range ◽  
Absolute Increase

PurposeTo evaluate the risk of epithelial ovarian cancer (EOC) recurrence in patients with rising serum cancer antigen 125 (CA-125) levels that remain below the upper limit of normal (< 35 U/mL).Patients and MethodsAll patients treated for EOC between September 1997 and March 2003 were identified and screened retrospectively for the following: (1) elevated serum CA-125 at time of diagnosis, (2) complete clinical and radiographic response (CR) to initial treatment with normalization of serum CA-125, (3) at least three serial serum CA-125 determinations that remained within the normal range, and (4) clinical and/or radiographic determination of disease status at the time of last follow-up or recurrence. For statistical analyses, univariate regression models were used to compare absolute and relative changes in CA-125 levels among patients with recurrent disease and those without EOC recurrence.ResultsA total of 39 patients satisfied study inclusion criteria; 22 patients manifested EOC recurrence at a median interval from complete response of 11 months. The median follow-up time from complete response to last contact was 32 months for the 17 patients in the no recurrence group. A relative increase in CA-125 of 100% (odds ratio [OR] = 23.7; 95% CI, 2.9 to 192.5; P = .003) was significantly predictive of recurrence. From baseline CA-125 nadir levels, an absolute increase in CA-125 of 5 U/mL (OR = 8.4; 95% CI, 2.2 to 32.6; P = .002) and 10 U/mL (OR = 71.2; 95% CI, 4.8 to > 999.9; P = .002) were also significantly associated with the likelihood of concurrent disease recurrence.ConclusionAmong patients with EOC in complete clinical remission, a progressive low-level increase in serum CA-125 levels is strongly predictive of disease recurrence.

CA 125 as a Screening Test for Ovarian Cancer

1996 ◽  
Vol 3 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Marti Hakama ◽  
Ulf—Håkan Stenman ◽  
Paul Knekt ◽  
Jorma Järvisalo ◽  
Timo Hakulinen ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Screening Test ◽  
Detection Rate ◽  
Case Control ◽  
Ca 125 ◽  
Serum Samples ◽  
True Negative ◽  
Matched Case ◽  
Discriminatory Performance

Background— Screening for ovarian cancer is based on ultrasound, colour Doppler, and tumour markers. There is only limited evidence on their discriminatory performance and no evidence on their effectiveness in reducing mortality. Objective— To investigate the discriminatory performance of CA 125 as a screening test for ovarian cancer. Methods— A registry of 15 093 serum samples drawn in 1968–72 was linked to the cancer registry. During follow up between 1968 and 1980 24 ovarian cancers were identified. One or two matched case—control design nested within the sample bank was applied and the concentrations of CA 125 were assessed. Results— Case—control differences (relative risk 4.0, 95% confidence interval 1.0 to 15.5 at 20kU/l) were found. Detection rate of the CA 125 test was 21–33% and the true negative rate was 75–98% depending on the cut off level and interval between drawing of the blood sample and diagnosis of the cancer. Conclusion— CA 125 is not a valid screening test if used alone. Case—control differences of borderline significance were found in CA 125 before diagnosis of ovarian cancer, but they were not large enough to provide a sufficient detection rate.

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