Peritoneal carcinosis of ovarian origin

Epithelial ovarian cancer (EOC) is the second most common genital malignancy in women and is the most lethal gynecological malignancy,with an estimated five-year survival rate of 39%.Despite efforts to develop an effective ovarian cancer screening method,60% of patients still present with advanced disease.Comprehensive management using surgical cytoreduction to decrease the tumor load to aminimum,and intraperitoneal chemotherapy to eliminate microscopic disease on peritoneal surface,has the potential to greatly improve quality of life and to have an impact on survival in ovarian cancer patients.Despite achieving clinical remission after completion of initial treatment,most patients (60%) with advanced EOC will ultimately develop recurrent disease or show drug resistance;the eventual rate of curability is less than 30%.Given the poor outcome of women with advanced EOC,it is imperative to continue to explore novel therapies.

Observations from the Working Group Peritoneal Carcinosis

The aim of this report was to describe the feasibility, overall survival and quality of life of combining multimodal therapy with a complementary therapy concept called LOTUS Care Cure program. The peritoneal carcinomatosis (PC) working group described their observations on the combination of multimodal therapy with a complementary therapy concept based on 132 patients with different cancer entities with suspected PC. PC was not confirmed by laparoscopy in 32.5% of the patients included in the working group of patients with suspected PC. Patient compliance and the feasibility were high. For Ki67, there is a cut-off at 45% with a slower progression at <45% and a faster progression of the disease at >45%. The higher the Karnofsky index, the more improved the therapy and tolerability, with a cut-off of 80%. Overall, 72.0% of patients died. The median survival time in the overall population was 3.74 years (95% CI, 2.57 to 4.91) with a sharp decline in the first 16 weeks. The quality of life of patients can be improved with the implementation of the complementary LOTUS Care Cure Project. Overall, the therapy of PC requires a multi-professional team of therapists and a multimodal therapy concept. The multimodal concept together with the Lotus Care Cure project shows very good feasibility with high compliance and ultimately leads to better and low-risk patient care.

Pelvic Tuberculosis Simulating an Ovarian Tumor at a Stage of Peritoneal Carcinosis

Tuberculosis is a global public health problem with 10 million people developing an active form each year. The exact incidence of the pelvic form of tuberculosis is not known due to under-reporting of asymptomatic cases, vague symptomatology and lack of reliable diagnosis. We report a case of ovarian tuberculosis mimicking cancer and peritoneal carcinosis. The case involved a 15-year-old girl, hospitalized for severe pelvic pain and secondary amenorrhea. The examination showed an altered general state, a fever, a sensitive distended abdomen. The biology showed an elevation of Ca125 to 357 IU/ml. The CT scan showed a latero-uterine mass taking contrast in a heterogeneous way with an irregular and nodular thickening of the peritoneum making evoke a peritoneal carcinosis. Exploratory laparotomy found a bilateral ovarian mass with ileo-ileal, ileo-parietal and ileo-ovarian adhesions. Biopsy of the mass and the peritoneum showed a caseo-follicular gigantocellular epitheloid granulomatosis.

Peritoneal carcinomatosis

Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity.The occurrence of peritoneal carcinomatosis(PC)has been shown to significantly decrease overall survival in patients with liver and/or extraperitoneal metastases from gastrointestinal cancer.During the last three decades,the understanding of the biology and pathways of dissemination of tumors with intraperitoneal spread,and the understanding of the protective function of the peritoneal barrier against tumoral seeding,has prompted the concept that PC is a loco-regional disease:in absence of other systemic metastases,multimodal approaches combining aggressive cytoreductive surgery,intraperitoneal hyperthermic chemotherapy and systemic chemotherapy have been proposed and are actually considered promising methods to improve loco-regional control of the disease,and ultimately to increase survival.The aim of this review article is to present the evidence on treatment of PC in different tumors,in order to provide patients with a proper surgical and multidisciplinary treatment focused on optimal control of their locoregional disease.

Intraperitoneal distribution of alginate microcapsules in mice

Introduction: Improved drug delivery mechanisms for the treatment of residual peritoneal cancer cells following cytoreduction surgery are needed. Alginate microcapsules are a potentially useful mechanism for delivery of bioengineered cells, but when injected into the peritoneum, their distribution and properties are not well described. Methods: Aliquots of 300, 600 or 1200 microcapsules were injected into the peritoneum of 81 mice. Mice were sacrificed at 6, 12, 18, and 48 days and laparotomy was performed to quantify the distribution of microspheres. Results: The injections were well tolerated for up to 48 days. No peritoneal adherence or inflammatory reaction was noted to the microcapsules. Injection of 1200 microcapsules resulted in a better overall persistence and widespread peritoneal distribution at up to 48 days. The volume of fluid used for injection of the microcapsules did not affect their distribution or persistence. Conclusion: The intraperitoneal injection of alginate microspheres allows wide and persistent distribution throughout the abdominal cavity. The next step is to test the distribution of microcapsules when delivered following surgery in a rodent model.