Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for management of recurrent/relapsed ovarian granulosa cell tumor: A single-center experience

• Published in: The journal of obstetrics and gynaecology research Vol. 40; no. 9; pp. 2066 - 2075
• Main Authors: Al-Badawi, Ismail A., Abu-Zaid, Ahmed, Azzam, Ayman, AlOmar, Osama, AlHusaini, Hamed, Amin, Tarek
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-09-2014
• Subjects: Abdominal Neoplasms - prevention & control; Abdominal Neoplasms - secondary; Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy, Adjuvant - adverse effects; Cisplatin - administration & dosage; Cisplatin - adverse effects; Cisplatin - therapeutic use; Combined Modality Therapy - adverse effects; Cytoreduction Surgical Procedures - adverse effects; cytoreductive surgery; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Feasibility Studies; Female; Follow-Up Studies; Granulosa Cell Tumor - drug therapy; Granulosa Cell Tumor - secondary; Granulosa Cell Tumor - surgery; Humans; Hyperthermia, Induced - adverse effects; hyperthermic intraperitoneal chemotherapy; Intraoperative Care; Middle Aged; ovarian granulosa cell tumor; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - surgery; Pelvic Neoplasms - prevention & control; Pelvic Neoplasms - secondary; Peritoneal Lavage; Retrospective Studies; Saudi Arabia; Tertiary Care Centers; Saudi Arabia; ovarian granulosa cell tumor; hyperthermic intraperitoneal chemotherapy; cytoreductive surgery
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.12460

Aim
The aim of this study was to retrospectively report our experience (efficacy/morbidity) with cytoreductive surgery+hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) for the management of recurrent/relapsed ovarian granulosa cell tumors (OGCT).
Material and Methods
From 2010 to 2013, six patients underwent CRS+HIPEC. CRS was performed with standard peritonectomy procedures and visceral resections directed towards complete elimination of tumors from the abdominopelvic cavity. HIPEC was performed with cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) and allowed to circulate in the abdominopelvic cavity for 90 min at 41.0–42.2°C.
Results
Cytoreduction completeness (CC‐0) was achieved in all except one patient (CC‐1). Five patients had OGCT recurrences in abdomen+pelvis and one patient in abdomen only. No grade V morbidity (Clavien–Dindo classification) occurred. Two patients developed lung atelectasis, which was managed by mere chest physiotherapy (grade I). One patient developed urinary tract infection (grade II) and another patient developed pneumonia (grade II) – both of which were managed by antibiotics. One patient developed splenic bed and anterior abdominal wall collections requiring ultrasound‐guided aspiration without general anesthesia (grade III). One patient developed pulmonary embolism requiring intensive care‐unit management (grade IV). Four chemo‐naïve patients received adjuvant chemotherapy whereas the remaining two previously chemo‐exposed patients received no adjuvant therapy. All patients were alive and disease‐free without proof of recurrence/relapse at 40, 32, 27, 24, 20 and 16 months. The average interval of follow‐up after CRS+HIPEC was roughly 27 months (range: 16–40 months).
Conclusion
CRS+HIPEC appears to be an efficacious and morbidly well‐tolerated therapeutic modality for recurrent/relapsed OGCT. Long‐term follow‐up data and further research are needed.