The impact of PET-CT in suspected recurrent ovarian cancer: A prospective multi-centre study as part of the Australian PET Data Collection Project.

OBJECTIVE: To assess the impact of FDG PET-CT on the management of patients with suspected recurrent ovarian cancer and to determine the incremental information provided by PET-CT. METHODS: This was a prospective, multi-centre, cohort study. Ninety women (mean age 59.9 years; age range 35-85 years) with a previous history of treated epithelial ovarian carcinoma and suspected recurrence based on elevated CA-125, anatomical imaging or clinical symptoms were studied with FDG PET-CT across two States. Referring doctors were asked to specify a management plan pre-PET, if management was altered after PET-CT and, the impact (rated - none, low, medium, high) of PET-CT on patient management. The pre-PET management plan could include radiotherapy, chemotherapy, surgery, and 'other' including observation. Patients were followed at 6 and 12 months and clinical status, evidence of recurrence and progression were recorded. RESULTS: Patients were referred by 34 individual specialists. At least 168 additional sites of disease in 61 patients (68%), not identified by conventional imaging were identified by PET-CT. In 77% the additional lesions were located below the diaphragm and most were nodal or peritoneal. PET-CT affected management in 60% (49% high, 11% medium impact). Patients where more disease was detected with PET-CT were more likely to progress in the following 12 months. CONCLUSIONS: For women with previously treated ovarian carcinoma with recurrent disease, PET-CT can: a) alter management in close to 60% of patients, b) detect more sites of disease than abdominal and pelvic CT, c) is superior in the detection of nodal, peritoneal and subcapsular liver disease and d) offers the opportunity for technology replacement in this setting.

Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study.

OBJECTIVES: The aims of this study were (1) to determine the incremental information provided by (18)F-FDG positron emission tomography (PET) in staging patients with oesophageal cancer, and (2) to determine the impact of PET staging on post-PET clinical management of oesophageal cancer, and on prognosis. METHODS: In a multicentre, single-arm open study, patients with proved oesophageal cancer without definite distant metastases and regarded as suitable for potentially curative treatment were examined by PET. Clinicians were requested to supply a management plan before and another plan after being supplied with the PET scan results. Patients were followed for at least 1 year for outcome analysis. RESULTS: A total of 129 patients (104 men, mean age 67 y) were recruited. PET detected additional sites of disease in 53 patients (41%). Significant changes in management (high or medium impact) were observed in 38% of patients, primarily as a result of identifying additional sites of disease and/or confirming previously equivocal regional and distant metastases. Progression-free survival was significantly shorter in patients found to have additional lesions on PET (p < 0.05), but was not related to SUV(max). CONCLUSION: These findings demonstrate the significant impact of PET on the clinical management of patients with newly diagnosed oesophageal carcinoma, and on prognostic stratification of these patients.

Psychological adjustment to coronary artery surgery.

In a study of psychological adjustment to coronary artery bypass surgery 23 patients who underwent surgery were seen pre-operatively, prior to discharge and one year after surgery. A comparison sample of 19 patients not tested pre-surgically was contacted by postal questionnaire one year post-operatively. An hierarchical grouping analysis carried out on seven outcome variables yielded a two-group solution for the study sample and this was replicated in the comparison sample. Group 1 indicated change for the better and Group 2 change for the worse since surgery. Discriminant function analysis of 23 pre-operative and operative variables for the first sample indicated ability to cope with stressful events and neuroticism were significant predictors of outcome. Patients in the comparison sample did not differ from the study sample in outcome measures, indicating no effect of assessment prior to operation for the study sample.

Individual differences in life-style response to coronary artery bypass surgery.

Fifty-three patients who had undergone coronary artery bypass surgery 12 to 27 months previously were given four standard personality questionnaires and asked to write about the main effects the operation had on their life-styles. These responses were then content analysed. Although hierarchical grouping analysis indicated that the responses could best be classified into four groups, only three distinct response profiles emerged. The first group described mainly adverse consequences of surgery; the other three groups described the effects of surgery as beneficial. Personality test data suggested that individual personality and coping style considerably influence a patient's perception of surgical outcome, and that this perception is largely independent of cardiac symptoms.