Metabolic active peritoneal sites affect tumor debulking in ovarian and peritoneal cancers

Rationale and objectives To evaluate the impact of metabolic parameters in the peritoneal cavity on the likelihood of achieving complete tumor debulking in patients with ovarian and peritoneal cancers. Materials and methods Forty-nine patients with ovarian and peritoneal cancers were included, who underwent pre-operative F-18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (F-18-FDG PET/CT). The immediate surgical outcome was dichotomized into complete and incomplete tumor debulking. F-18-FDG PET/CT was qualitatively and quantitatively assessed by scrutinizing 15 anatomical sites for the presence of peritoneal carcinomatosis (PC). Patient-based and site-based diagnostic characteristics were described. Metabolic parameters (SUVmax, metabolic tumor volume and total lesion glycolysis) and the number of F-18-FDG avid peritoneal sites were evaluated between the two groups. Receiver operating curve (ROC) analysis was performed to determine the optimal cut-off value in predicting incomplete tumor debulking. Results Twenty-seven out of the 49 patients had PC and 11 had incomplete debulking. Patient-based and site-based accuracies for detection of PC were 87.8 and 97.6%, respectively. The number of F-18-FDG avid peritoneal sites was significantly different between complete and incomplete debulking groups (0.6 +/- 0.8 versus 2.3 +/- 1.7 sites respectively, p = 0.001), and the only independent significant risk factor among other metabolic parameters tested (odd ratio = 2.983, 95% CI 1.104-8.062) for incomplete tumor debulking with an optimal cut-off value of >= 4 (AUC = 0.816). Conclusion The number of F-18-FDG avid peritoneal sites increased the risk of incomplete tumor debulking after surgery and potentially useful in assisting treatment stratification in patients with ovarian and peritoneal cancers.