CA-125 levels after surgical exploration and radioactive chromic phosphate in ovarian cancer patients

Trends in CA-125 levels after completion of therapy in ovarian cancer patients who received intraperitoneal radioactive chromic phosphate therapy (³²P) after primary surgical resection or second-look surgery were evaluated. Ninety patients who underwent surgical exploration and ³²P were reviewed. Twenty-nine patients were excluded due to insufficient number of CA-125 levels or recurrence within 12 months, with 61 patients with serial CA-125 levels and no evidence of disease for 12 months available for analysis. ³²P followed initial resection in 24 patients (16 Stage I, 3 Stage II, 5 Stage III). ³²P followed chemotherapy and second-look procedures in 37 patients (4 Stage I, 3 Stage II, 27 Stage III, 3 Stage IV). Elevated CA-125 levels were present in 25 (41%) patients within 12 months of ³²P (46% after primary exploration, 38% after second-look). The degree of CA-125 elevation (U/ml) was 30-100 (23%), 100-200 (11%), and >200 (7%). Of the 25 patients with an elevated CA-125, the elevation persisted more than 4 months in 11 (44%). All but two patients had normal CA-125 levels by 12 months. An abnormal elevation in CA-125 was seen in 33% of patients 4 months after receiving ³²P and abdominal surgery, with values ranging as high as 500 U/ml. Although elevations in CA-125 are reported following surgery alone, the duration of elevation appears to be longer with ³²P. Therefore, persistent elevations of CA-125 following ³²P between 4 and 12 months should be judged with caution as they may not reflect recurrent disease.