Intraperitoneal cisplatin and doxorubicin as maintenance chemotherapy for unresectable ovarian cancer: a case report

Clemens B Tempfer, Franziska Hartmann, Ziad Hilal, Günther A Rezniczek, Clemens B Tempfer, Franziska Hartmann, Ziad Hilal, Günther A Rezniczek

Abstract

Background: Primary advanced, unresectable ovarian cancer (OC) is treated with palliative systemic chemotherapy. Intraperitoneal chemotherapy may be an alternative local maintenance therapy.

Case presentation: A 75 year old woman with laparoscopically and histologically confirmed unresectable OC was treated with 13 cycles of intraperitoneal cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 over 2 years using laparoscopic pressurized intraperitoneal aerosol chemotherapy (PIPAC). Objective tumor response (tumor regression on histology, stable disease on repeated video-laparoscopy and peritoneal carcinomatosis index) was noted. No Common Terminology Criteria for Adverse Events (CTCAE) > grade 3 were observed. EORTC QLQ-C30 quality of life measurements were stable throughout the therapy.

Conclusions: Repeated intraperitoneal chemotherapy with cisplatin and doxorubicin applied as PIPAC may be an effective maintenance treatment in women with primary advanced, unresectable OC.

Keywords: Adverse effects; Antineoplastic agents; Intraperitoneal chemotherapy; Maintenance; Ovarian cancer; PIPAC; Peritoneal carcinomatosis; Quality of life.

Figures

Fig. 1
Fig. 1
Intraoperative findings (macroscopy) during video-laparoscopy before the first (panels a–c), fourth (panel d), seventh (panel e), and twelfth (panel f) pressurized intraperitoneal aerosol chemotherapy (PIPAC) application. During the course of therapy, sclerosis and flattening of peritoneal nodules as well as reticular scarring of the visceral and parietal peritoneum were observed
Fig. 2
Fig. 2
Intraoperative findings (microscopy) before the first pressurized intraperitoneal aerosol chemotherapy (PIPAC) (a), and during consecutive PIPAC cycles (PIPAC #3 (b), PIPAC #5 (c), and PIPAC #6 (d). Panel A shows peritoneal manifestations of a serous carcinoma with large, pleomorphic nuclei and frequent mitosis. Histopathological specimens taken during consecutive PIPACs 3, 5, and 6 (panels b, c, and d, respectively) show residual peritoneal tumor foci with reduced cellularity and fibroelastic connective tissue and associated inflammatory changes such as fibrinous exudate, fibrosis, foreign-body reaction, and hemosiderin-laden macrophages. Bars, 100 μm
Fig. 3
Fig. 3
Scatter plots demonstrating serum levels of gamma glutamyl transferase (γGT), aspartate aminotransferase (GOT/ASAT), alanine aminotransferase (GPT/ALAT), lactate (LDH), alkaline phosphatase (ALP), C-reactive protein (CRP), bilirubin, creatinine (CREA), hemoglobin (Hb) and Quick values throughout 13 pressurized intraperitoneal aerosol chemotherapy (PIPAC) procedures. Linear regression lines are shown (solid. Pearson product moment correlation with p < 0.05; dotted, no correlation)
Fig. 4
Fig. 4
European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3.0) scores. GHS/QL2, global health status/QoL (revised). Functional scales: PF2, physical functioning (revised); RF2, role functioning (revised); EF, emotional functioning; CF, cognitive functioning; SF, social functioning. Symptom scales/items: FA, fatigue; NV, nausea and vomiting; PA, pain; IN, insomnia; AL, appetite loss; CO, constipation; DI, diarrhea; FD, financial difficulties. Diamonds represent consecutive pressurized intraperitoneal aerosol chemotherapies (PIPACs, cycles 1–13; note: data for cycle 3 are missing)

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