Multimodal oncosurgery approach to treat peritoneal carcinomatosis in a patient with occlusive ovarian carcinoma

Background: This paper aims to present a "pattern" of oncosurgery solution in a case generally considered unrecoverable: intestinal occlusion in case of ovarian carcinoma and carcinomatosis. Case Report: A 62-year-old female patient with ascites, carcinomatosis, unresectable pelvic tumour, and intestinal obstruction suffered a five-step oncosurgery "model": three surgical interventions overlapping chemotherapy administered via the systemic and intraperitoneal route: Step 1: colostomy and partial omentectomy; Step 2: five courses of systemic chemotherapy supported by granulocyte colony-stimulating factor; Step 3: radical surgery - total hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, omentectomy, appendectomy, pelvic peritonectomy, and hyperthermic intraperitoneal chemotherapy; Step 4: consolidation systemic chemotherapy consisting of three more similar cycles; Step 5: closure of the colostomy. Nine months after the beginning of treatment, the patient is with no evidence of disease. Conclusions: The association of surgical and oncologic treatment and the use of hyperthermic intraperitoneal chemotherapy (HIPEC) technology can solve some of these complex cases.

Peritoneal carcinomatosis; Occlusive ovarian cancer; Hyperthermic intraperitoneal chemotherapy.

[1] Jemal A., Siegel R., Ward E., Murray T., Xu J., Thun M.J.: “Cancer statistics, 2007”. CA Cancer J. Clin., 2007, 57, 43.

[2] Chua T.C., Robertson G.,·Liauw W., Farrell R., Yan T.D., Morris D. L.: “Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results”. J. Cancer Res. Clin. Oncol., 2009, 135, 1637.

[3] Neijt J.P., Engelholm S.A., Tuxen M.K., Sorensen P.G., Hansen M., Sessa C., et al.: “Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer”. J. Clin. Oncol., 2000, 18, 3084.

[4] Königsrainer I., Beckert S., Becker S., Zieker D., Fehm T., Grischke E. M., et al.: “Cytoreductive surgery and HIPEC in peritoneal recurrentovarian cancer: experience and lessons learned”. Langenbecks Arch. Surg., 2011, 396, 1077.

[5] Deraco M., Kusamura S., Virzì S., Puccio F., Macrì A., Famulari C., et al.: “Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial”. Gynecol. Oncol., 2011, 122, 215.

[6] Pomel C., Ferron G., Lorimier G., Rey A., Lhomme C., Classe J.M., et al.: “Hyperthermic intra-peritoneal chemotherapy using oxaliplatin as consolidation therapy for advanced epithelial ovarian carcinoma. Results of a phase II prospective multicentre trial. CHIPOVAC study”. Eur. J. Surg. Oncol., 2010, 36, 589.