The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .
Whole-body MRI with diffusion-weighted sequence for staging of patients with suspected ovarian cancer: a clinical feasibility study in comparison to CT and FDG-PET/CT
Objectives To evaluate whole-body MRI with diffusion-weighted sequence ( WB-DWI/MRI ) for staging and assessing operability compared with CT and FDG-PET/CT in patients with suspected ovarian cancer . Methods Thirty-two patients underwent 3-T WB-DWI/MRI , 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( FDG-PET/CT ) and CT before diagnostic open laparoscopy  ( DOL ) . Imaging findings for tumour characterisation , peritoneal and retroperitoneal staging were correlated with histopathology after DOL and /or open surgery . For distant metastases , FDG-PET/CT or image-guided biopsies were the reference st and ards . For tumour characterisation and peritoneal staging , WB-DWI/MRI was compared with CT and FDG-PET/CT . Interobserver agreement for WB-DWI/MRI was determined . Results WB-DWI/MRI showed 94 % accuracy for primary tumour characterisation compared with 88 % for CT and 94 % for FDG-PET/CT . WB-DWI/MRI showed higher accuracy of 91 % for peritoneal staging compared with CT ( 75 % ) and FDG-PET/CT ( 71 % ) . WB-DWI/MRI and FDG-PET/CT showed higher accuracy of 87 % for detecting retroperitoneal lymphadenopathies compared with CT ( 71 % ) . WB-DWI/MRI showed excellent correlation with FDG-PET/CT ( κ = 1.00 ) for detecting distant metastases compared with CT ( κ = 0.34 ) . Interobserver agreement was moderate to almost perfect ( κ = 0.58–0.91 ) . Conclusions WB-DWI/MRI shows high accuracy for characterising primary tumours , peritoneal and distant staging compared with CT and FDG-PET/CT and may be valuable for assessing operability in ovarian cancer patients .Key Points• Whole-body MRI with diffusion weighting ( WB-DWI/MRI ) helps to assess the operability of suspected ovarian cancer.• Interobserver agreement is good for primary tumour characterisation , peritoneal and distant staging.• WB-DWI/MRI  improves mesenteric/serosal metastatic spread assessment compared with CT and FDG-PET/CT.• Retroperitoneal/cervical-thoracic nodal staging using qualitative DWI criteria was reasonably accurate.• WB-DWI/MRI and FDG-PET/CT showed the highest diagnostic impact for detecting thoracic metastases
The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .