Implantable Port System Cytology for Ovarian Cancer To Evaluate Chemotherapy Response
Shinichi Tate, Kyoko Nishikimi, Noriko Yamamoto, Takashi Uehara, Hirokazu Ushui, Akira Mitsuhashi, Makio Shozu. Chiba University Hospital, Chiba, Japan
Background: Neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) for advanced ovarian cancer has been shown to be not inferior to primary debulking surgery. However, appropriate number of chemotherapy cycles in NAC are controversial. Clinically, we have evaluated chemotherapy response only using tumor marker for ovarian cancer, CA 125, and radiographic study. In this prospective pilot study, we evaluated morphologic change of cancer cells in implantable port system (IPS)-cytology for chemotherapy response and the relation between IPS-cytology and CA 125.
Design: Patients eligible for this study were those who had unresectable residual disease at the initial surgery. At the initial surgery, the IPS was placed in patient's abdominal wall. To obtain IPS-cytology, 500ml of saline was infused. More than 20ml of saline was collected for cytological evaluation. We performed IPS-cytology every 3-4 weeks during neoadjuvant chemotherapy done. IDS was performed in principle after patients had achieved negative IPS-cytology. We evaluated morphologic change of cancer cells in IPS-cytology during NAC. The morphologic change was compared to CA 125.
Results: Twenty-seven patients were enrolled into this study. All patients had extensive stage T3c disease. Median CA 125 value was 1133 IU/ml in all patients. Five patients had progression disease before IDS was performed. Twenty-two patients received interval debulking surgery after NAC. We observed as following morphologic change of cancer cells in IPS-cytology. At initial surgery, numerous large clusters of cancer cells were observed in IPS-cytology. The clusters were arranged in papillary aggregate. After several chemotherapies were done, papillary clusters had arranged in decreasing papillosity and the number of cancer clusters decrease and the size became smaller. Some cancer clusters had arranged in sheets patterned. Then, cancer clusters were arranged smaller with scant cytoplasm. The cancer cells showed isolated with some degree of degeneration and some nuclei enlarged, subsequently. After isolated cancer cells were observed, we found negative IPS-cytology. Twenty-one of 27 patients had negative IPS cytology. Median period of change to negative IPS-cytology was 19.6 weeks from date of starting chemotherapy, while median period of change to less than 35 IU/ml in CA 125 was 10.1 weeks.
Conclusions: This study revealed patients receiving neoadjuvant chemotherapy achieved negative IPS-cytology exclusively after isolated cancer cells were observed. IPS-cytology are effective to evaluate direct response of NAC for advanced ovarian cancer.
Monday, March 4, 2013 1:00 PM
Poster Session II # 96, Monday Afternoon