Abstract
Malignant small bowel obstruction (MSBO) occurs in up to 50% of women with advanced epithelial ovarian cancer (EOC) causing symptom burden and distress to women and their families, particularly in the terminal stages of the disease. Corticosteroids are used to promote symptom resolution in malignant small bowel obstruction (MSBO) related to EOC, with little published data on their efficacy, optimal dosing and duration of treatment. To evaluate the efficacy of dexamethasone in achieving symptom control in women with advanced EOC presenting with MSBO, assess dexamethasone dosing and efficacy over subsequent presentations, and examine differences in dexamethasone responsiveness between platinum-resistant and platinum-sensitive patient. This is a retrospective cohort study of women presenting with MSBO due to advanced EOC over a 12-year period from January 2005 to December 2016 in a single tertiary hospital. Ninety-one women with MSBO were administered dexamethasone over 154 admissions with 89% of women initially achieving partial or complete symptom control. Dexamethasone responsiveness did not change with recurrent admissions, and platinum responsive patients were more likely to respond to dexamethasone than platinum-resistant patients (OR 3.6 [95%CI 1.1 to 12.2, p = 0.04]). A total of 15.6% of patients required additional measures to control symptoms of MSBO, and 44.8% had adequate symptom resolution to allow them to remain on or commence further treatment for EOC. Dexamethasone therapy is a useful adjunctive therapy in the management of symptoms associated with MSBO in women with EOC.
Highlights
Malignant small bowel obstruction (MSBO) occurs in up to 50% of women with advanced epithelial ovarian cancer (EOC) causing symptom burden and distress to women and their families, in the terminal stages of the disease
Dexamethasone responsiveness did not change with recurrent admissions and platinum responsive patients were more likely to respond to dexamethasone than platinum resistant patients. 15.6% of patients required additional measures to control symptoms of MSBO and 44.8% had adequate symptoms resolution to allow them to remain on or commence further treatment for EOC
Dexamethasone therapy is a useful adjunctive therapy in the management of symptoms associated with MSBO in women with EOC
Summary
Malignant small bowel obstruction (MSBO) occurs in up to 50% of women with advanced epithelial ovarian cancer (EOC) causing symptom burden and distress to women and their families, in the terminal stages of the disease. [8, 9] Malignant small bowel obstruction (MSBO) in advanced ovarian cancer is thought to be due to several factors: diffuse intra-peritoneal carcinomatosis infiltrating the bowel wall with oedema and accumulation of intramural cytokines leading to dysfunctional bowel motility; large volume deposits causing extrinsic or intramural occlusion from tumour growth; mesenteric and coeliac plexus deposits affecting the autonomic nerve supply; and adhesions preventing normal peristaltic action. Acute MSBO can preclude the commencement of subsequent lines of cytotoxic therapies in eligible patients meaning MSBO needs to be managed to facilitate further therapy where indicated
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Schedule a callMore From: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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