Combattere il tumore con molte armi, ipertermia
CYTOREDUCTION AND HYPERTHERMIC ANTIBLASTIC PERITONEAL PERFUSION IN RECURRENT OVARIANT CANCER AFTER 1ST LINE OF CHEMOTHERAPY
M.De Simone, R.Barone, M.Nano, A.Bacino, E.Villata, M. Vaj , C.Franco, P. Cassolino, R.Camerano, A.Cistaro
Università di Torino – Azienda Ospedaliera S.Giovanni; Torino, Italy
The survival of patients with advanced ovarian carcinoma is 20% to 5 years. The middle survival at the moment of the recurrence after the first line of chemotheraphy ranged from 16 to 20 months. After surgical remove of a ovarian cancer at II or III stage, the recurrence is to load of peritoneum in 90% of cases. Initial studies regards the cytoreduction+chemo-hyperthermya in multi-recurrences ovarian carcinoma have given encouraging results, so that they stuffed us to propose a protocol of treatment in order to appraise the impact of the methodic on patients with first neoplastic recurrence intraperitoneal after chemotherapy. The protocol foresees also the execution of the lymphadenectomy, where it had not been already performed. A sistemic chemotherapy of consolidation within 5 weeks after intervention is provided.
Materials and methods : 5 patients with intraperitoneal recurrence, appearance not before 3 months from the end of chemotherapy effected for primitive ovarian cancer, have been enlisted. They have been submitted to laparotomy with surgical cytoreduction, up to reach max tumoral dimensions, for every knot, of 1cm and to lymphadenectomy aorto-cavale and iliac-hypogastric. The hyperthermic-antiblastic intraperitoneal perfusion has been performed with 25 mg/l/mq of Cisplatino, in 4 liters solution, at temperature of 42°C on peritoneum, for 90mins. In all patiens the peritoneum illness was not particularly advanced (Peritoneal Cancer Index ranged from 1 to 10). The cytoreduction has been complete in all cases. In three cases the lymphadenectomy has been performed. In a case had been already done during the first surgical interventionOnly one patient has resulted N+.
Results and conclusions : Nobody of the treated patiens have had post-operating complications, neither local or systemic toxicity from Cisplatino except one case which suffered for a very long post-operative ileum. The therapeutic meaning of the lymphadenectomy is still uncertain and the literature data scarce still. Any complications due to the association lymphadenectomy+peritoneal perfusion, occured in our cases. In the other hand, once performed the pelvic pertonectomy, the lymphadenectomy aorto-cava-iliac-hypogastric is easy enough and it prolongs surgical time of c.ca 90-120 mins.
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