Assessment Of Difference In Quality Of Life Due To PET/CT A Hybrid Imaging Modality In Advanced Epithelial Ovarian Cancer Patients In Complete Remission After Primary Treatment

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Ramya Soundararajan , G. P. Bandopadhyaya , Rakesh Kumar , Lalit Kumar , Sunesh Kumar , Suhas Singla


AIM: To assess and compare the quality of life of advanced epithelial ovarian cancer patients with the impact of 18F-FDG PET/CT in detection of residual or persistent disease after primary treatment.

MATERIALS AND METHODS: Prospective observational study was done in 38 patients (mean age=48.1 ±10.6 years)from July 2010-July 2012).Patients on complete remission (CR) with normal CA-125 / computed tomography/ultrasound imaging after debulking surgery and primary adjuvant platinum-based chemotherapy were included and 18F-FDG PET/CT was done. 10mCi of 18F-FDG was injected i.v after 6 hrs fasting and whole-body scans were acquired after 45 - 60 minutes in Siemens Biograph 2 PET/CT scanner. Histopathology or follow up imaging/clinical follow up were kept as the reference standard. Patients were asked to fill up/complete quality of life(QOL) questionnaires at two points in the study, after completion of primary treatment and three months after PET/CT. QOL was measured using version 4 of the Functional Assessment of Cancer Therapy –Ovarian (FACT-O). Scores will be evaluated using FACT-O scoring model and QOL before and after PET/CT during the course of disease is evaluated.

RESULTS: Among total 38 patients, 18F-FDG PET/CT detected residual disease initially in 10 patients and were offered salvage chemotherapy. Hence the detection rate of residual disease in patients in CR by 18F-FDG PET/CT is 26% [95% CI = 4.79-18.39]. There was no statistically significant difference in the mean QOL score before PET-CT (p value = 0.800) and after PET-CT(p value = 0.103)  for patients who had negative PET-CT scans compared to who had positive results in PET-CT. The present disease status of the patients and QOL of patients who underwent 18F-FDG PET/CT also was not influenced PET/CT results.

No statistically significant difference (p value = 0.602) was found in the mean QOL score before PET/CT in patients remained in CR compared to patients with progressive disease post salvage chemotherapy. Borderline statistically significant difference (p value = 0.051) is noted in the mean QOL score, three months after PET/CT had detected residual disease in patients with complete remission compared patients who had progressive disease.

Among the 28 patients with normal PET/CT scan post primary treatment no statistically significant difference (p value = 0.163) was found in the mean QOL score for patients in complete remission compared to patients who relapsed, However, the mean QOL score three months after PET-CT for patients in complete remission compared to patients who relapsed, the difference being statistically significant (p value < 0.001).

CONCLUSION: The Quality of Life (QOL) after three months of PET/CT scan was substantially lower in patients with progressive disease, who had abnormal PET/CT scan compared to baseline QOL after primary treatment, which supports the impact of PET/CT in QOL of the patients.

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