CA-125: an inaccurate surveillance tool immediately after cytoreductive surgery and hyperthermic intraoperative chemotherapy (CRS-HIPEC)?. (4th July 2018)

• Record Type: Journal Article
• Authors: Shannon, Nicholas Brian; Tan, Grace Hwei Ching; Chia, Claramae Shulyn; Soo, Khee Chee; Teo, Melissa Ching Ching
• Is Part Of: International journal of hyperthermia. Volume 34:Number 5(2018)
• Page Start: 585
• Page End: 588
• Publication Date: 2018-07-04
• Subjects: Regional perfusion cancer chemotherapy -- cytoreduction surgical procedures -- peritoneal neoplasms -- tumour biomarkers; Thermotherapy -- Periodicals; 615.832
• DOI: 10.1080/02656736.2017.1342874
• Languages: English
• ISSNs: 0265-6736

Abstract

Abstract: Objective: This study seeks to evaluate pre and post-operative CA-125 in patients undergoing complete cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and understand the time frame before values normalise allowing use as a surveillance tool to resume. Methods: A retrospective review was carried out of 94 patients undergoing CRS-HIPEC to compare pre-operative CA-125 values, measured within one week prior to surgery to post-operative readings within the first 30 d. Raised CA-125 was defined using as a value >35 U/ml. Results: Of 63 (67%) patients with normal pre-operative CA-125, 22 (35%) had raised post-operative CA-125, and consisted of patients with colorectal ( n = 8), appendiceal ( n = 6), ovarian ( n = 4) or other ( n = 4) cancers. The average peak CA-125 was 80 U/ml occurring on median 10th post-operative day (POD) (range 7–30). The median day of normalisation for patients with normal pre-operative and raised post-operative CA-125 was 57 (range 28–115). The median day of normalisation for patients with raised pre-operative CA-125 was POD 41 (range 1–114). Notably 10 patients had initial normalisation (median POD 1, range 1–6), followed by subsequent raised value (median POD 10, range 5–40) and re-normalisation (median POD 47, range 19–104). Discussion: For patients with raised pre-operative CA-125 an immediate post-operative CA-125 within 3 d may be useful to assess normalisation following surgery. Aside from immediate measurement CA-125 is misleading and should not be measured post-operatively within the first 3 months after surgery following which its use as a surveillance marker can resume.