Abstract
BackgroundEpithelial ovarian cancer (EOC) has the worst prognosis in all of gynecologic malignant tumors because of its high recurrence and eventually chemo-resistance. Early diagnosis of recurrence is crucial to avoid diffuse dissemination. Failure of traditional treatment in recurrent epithelial ovarian cancer remains a challenge for clinicians. On the other hand, 125I brachytherapy has been accepted as a useful and hopeful treatment for multiple advanced cancers in recent years. However, its success in advanced epithelial ovarian cancer is limited. Here we report a case of recurrent ovarian cancer who had been early diagnosis of isolated recurrence and successfully treated with 125I seeds implantation during suboptimal cytoreductive surgery.Case presentationA 59-year-old woman presented with recurrent epithelial ovarian cancer who have had a history of ovarian cancer stage IIIB and an R0 resection had been achieved nearly 2 years before presented in our hospital. She underwent suboptimal secondary cytoreductive surgery after four cycles of chemotherapy with little effectiveness and severe chemotherapy-related side effects. Approximately 70% of the cancer-bulk was resected during surgery. For residual lesion which fixed around the right ureter and right external iliac vessel, 125I seeds implantation was performed. Postoperatively, the patient was treated with two cycles of combination chemotherapy with paclitaxel and carboplatin. The patient was free of disease at 26 months’ follow-up period.ConclusionIn recurrent EOC patients with unresectable isolated lesion, salvage 125I seeds implantation are feasible and may contribute to survival.
Highlights
Epithelial ovarian cancer (EOC) has the worst prognosis in all of gynecologic malignant tumors because of its high recurrence and eventually chemo-resistance
Epithelial ovarian cancer (EOC) always remains the most lethal gynecologic malignancy, guideline-recommended treatments for advanced ovarian cancer is primary debulking surgery followed by platinum-based chemotherapy
Other researches in ovarian cancer in progress include multiline or dose-dense chemotherapy and targeted agents such as PARP inhibitors, Anti-angiogenic agents, immunotherapies
Summary
In all of the gynecologic malignant tumors, epithelial ovarian cancer (EOC) has the worst prognosis. The treatments for recurrent epithelial ovarian cancer include secondary cytoreductive surgery, chemotherapy, targeted therapy, immunotherapy, radiotherapy, and so on. We present a case of recurrent epithelial ovarian cancer successfully early diagnosed and treated with 125I seeds implantation during suboptimal cytoreductive surgery. The patient had been submitted to cytoreductive surgery nearly 2 years before (January 2016). At that time, she complained of lower abdominal pain and bilateral pelvic mass with elevated serum CA125 level of 778.1 u/ml and HE4 level of 609 pmol/L. 18 G implantation needles were inserted directly into the target lesions avoiding puncture of large blood vessels and nearby ureter, a turntable gun was used to place 125I seeds into recurrent tumors. Histopathological results confirmed the recurrence with malignant cells that invaded the small intestine with negative resection margins. Postoperative MRI and computed tomography (CT) were performed as Fig. 4
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