MROC: MR in Ovarian Cancer

• Research type

  Research Study

• Full title

  The Impact of Multiparametric MRI on the Staging and Management of Patients with Suspected or Confirmed Ovarian Cancer.

• IRAS ID

  173980

• Contact name

  Andrea Rockall

• Contact email

  a.rockall@imperial.ac.uk

• Duration of Study in the UK

  4 years, 0 months, 31 days

• Research summary

  Research Summary
  In patients with suspected Ovarian Cancer (OC), current guidelines recommend that a CT scan is performed in order to inform decisions as to what stage the cancer is at, and if the patient should have up-front surgery. Recent developments in MRI imaging have led to a new MRI technique called multiparametric MRI (mpMRI), which has the potential to provide additional information that may influence decisions about how the patient should be treated.\n\nThe aim of this study is to compare the staging of cancer and treatment plans for patients with suspected or confirmed OC, based upon findings from a CT alone, an mpMRI alone or a combination of CT and mpMRI. \n\n645 women with suspected or confirmed OC will be recruited onto the study and will undergo an mpMRI in addition to the standard of care CT. The MDT (the medical team who make decisions about a patients care) will then determine the stage and treatment plan for the patient based upon the CT alone. Any critical findings from the mpMRI will be revealed to the MDT after they have made an initial decision; the patient will then progress with treatment, as decided. A series of theoretical staging decisions and treatment plans will also be produced by the local team and two external MDTs. 6 months after entry onto the study, the local MDT will conduct a final case review. All available information will be reviewed and the correct stage and treatment plan for that particular patient will be determined. \n\nDuring the study, patients will only attend one extra appointment for the mpMRI, all other data will be provided by their medical records and the MDTs. Participating patients will also be given the option to donate tissue samples, which would be obtained during surgery.\n

  Summary of results

  MROC is a study looking at using mpMRI scans in staging and treatment decisions for ovarian cancer.

  MROC was a study for women who might have had ovarian cancer and some women who had ovarian cancer. The women with cancer received chemotherapy and some went on to have surgery.

  Background Information and Trial Design
  Surgery is the usual treatment for ovarian cancer. A CT scan is used to check where the cancer is in the body and helps doctors to know if surgery would be a suitable treatment choice. But sometimes the CT scan can’t
  - tell the difference between disease that is not cancer (benign) and cancer (malignant disease)
  - always show how far the cancer has spread (the stage of the cancer)
  - show when it is best to have an operation

  This means that some women have surgery and don’t need it because they don’t have cancer. And some women go for an operation and are then unable to have the cancer removed because it has spread too far.

  A multi parametric or mpMRI scan is a high definition scan. It might be better than a CT scan at showing what is cancer and what is healthy tissue.

  In this trial doctors wanted to see if an mpMRI scan is better than a CT scan before surgery in showing who needs an operation and how big the operation should be. They wanted to see if an mpMRI scan should either replace or be used as well as a CT scan.

  Results
  647 women had standard-of-care CT and research-MRI. Treatment plans were then recorded based on CT-alone, MRI-alone then CT&MRI combined. We collected everything that happened to the patient for 9 months and then asked expert consensus teams to review and record the stage (extent) of disease and the optimal treatment, knowing everything that happened. Treatment plans using MRI were more likely to agree with optimal treatment, by 9 to 10%, in patients being considered for initial surgery, and 13% in patients that underwent initial surgery, despite no improvement in detection of advanced ovarian cancer. MRI did not improve treatment planning in patients who had undergone initial chemotherapy before considering surgery.

  MRI has the potential to reduce over-extensive or unnecessary surgery and can be recommended in women with suspected ovarian cancer.
  

• REC name

  London - Bromley Research Ethics Committee

• REC reference

  15/LO/1904

• Date of REC Opinion

  24 Nov 2015

• REC opinion

  Favourable Opinion