cc 071015 elly marlina

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CASE CONFERENCEOctober 7th, 2015

Mrs. Elly Marlina Siahaan, P3, 55 years old, 367 44 89Localized Recurrent Ovarian Cancer

CASE DESCRIPTI!

Chief complaint: abdominal enlarement !ince " month! before comin to

oncolo# #necolo# o$tpatient clinic department Cipto %an$n&$!$mo 'o!pital

on Febr$ar# 21!t 2012( At the beinnin, !he )a! admitted to *$dhi A!ih +eneral

'o!pital, told to hae !$!pected oarian cancer and p$lmonar# t$berc$lo!i!,

then re-ered to Cipto %an$n&$!$mo 'o!pital( She lo!t 5 & )eiht in " month!(

She al!o complained abo$t bloatin, lo!! of appetite, di!t$rbance in mict$rition

and defecation( No hi!tor# of malinanc# on the enital tract, brea!t or colon in

the famil#( She )a! alread# menopa$!e for " #ear! )hen admitted to ho!pital(

.re operatie e/amination: c#!tic ma!! )ith !olid part diameter 7 cm, Ca 125:

112, m3, R%4: 75,( She $nder)ent laparotom# !$boptimal deb$l&in on

%arch 1th 2012 )ith re!id$ on rect$m( 'i!topatholo# re!$lt: adenocarcinoma

)ith moderate di-erentiation( She )a! ien chemotherap# )ith carboplatin and

paclita/el for c#cle! follo)in the !$rer#, ended on September 2012 and al!o

treatment for the p$lmonar# t$berc$lo!i!( No ma!! )a! fo$nd and Ca125 leel

)a! normal after the chemotherap#( Follo) $p period )a! $neentf$l $ntil abo$t

a month ao )hen !he !tarted to complain abo$t abdominal di!comfort(.h#!ical e/amination:

+eneral !tat$!: no enlarement of the l#mph node!, there )ere $mbilical hernia,

no ma!! palpable in the abdomen(

+#necoloical !tat$!: !olid ma!! )a! palpated on the left !ide of the ainal

a$lt, diameter " cm, 6/ed(

Ca125 September 8rd 20159: 12 m3

ltra!o$nd September 1th 20159:

Concl$!ion: oarian carcinoma po!t A' *SO( C#!tic ma!! )ith !olid part on

cranial of the ainal a$lt po!!ibl# rec$rrent t$mor(

C Scan September 22nd 20159:Concl$!ion: !oft ti!!$e ma!! predominant of c#!tic part in the left pelic cait#,

!$!pected rec$rrent, $mbilical hernia, contracted left &idne# )ith nephrolithia!i!

and pelio&aliecta!i! and !$!pected pne$monia(

C"I!ICA" #$ESTI!

;hat i! the ne/t be!t manaement for thi! patient<

. 55 #ear! old )omen, .8 )ith locali=ed rec$rrent oarian

cancer4 Secondar# c#tored$ctie !$rer#

C Chemotherap#O S$rial

1



T%E SEARC%

Da&a'ase Sear(h s&ra&e)y %i&s Sele(&ed ar&i(les.$b%ed rec$rrent oarian

cancer9 AN>manaement9

1" 8

Science>irect rec$rrent oarian

cancer9 AN>

manaement9

12 8

Cochrane rec$rrent oarian

cancer9 AN>

manaement9

?? 8

*EST E+IDE!CE PAPERS

A$thor .atient!ro$p

O$tcome Re!$lt Comment!

Chi >S,

%cCa$ht#

@, >ia= .,

et al(, 200,

Cancer

157 patients

underwent

secondary

cytoreduction

(153 were

evaluable)

Median

survival

41.7 months (95%

confidence interval,

36.0-47.2 months).

Significant survival

benefit was

demonstrated for re-

sidual disease that

measured < 0.5 cm.

The disease-free

interval and the number

of recurrence sites

should be used as

selection criteria foroffering secondary

cytoreduction.

Salani R,

Santillan A,

Bah$ra&

%3, et al(,

2007,

Cancer

Fifty-five

patients met the

study inclusion

criteria(complete

clinical response

to primary

therapy, >12

months between

initial diagnosis

and recurrence,

and < 5

recurrence sites

on preoperative

imaging studies)

Statistically

significant and

independent

predictors of

overall

survival

Diagnosis-to-

recurrence interval

>18 months (median

survival, 49 months

vs 3 months; P < .01)

Number of

radiographic

recurrence sites

(median survival, 50

months for patients

with 1 or 2 sites vs

12 months for

patients with 3 to 5

sites; P < .03)

Residual disease

(median survival, 50months for patients

Age, tumor grade,

histology, CA-125

level, ascites, and

tumor size were not

associated signifi-

cantly with survival.

Localized recurrent

ovarian cancer: patients

with 1 or 2

radiographic recurrence

sites a diagnosis-to-

recurrence interval >18

months and complete

secondary surgical

cytoreduction a

median postrecurrence

survival of

approximately 50

months.

2



with no macroscopic

residual disease vs

7.2 months for

patients with

macroscopic residual

disease; P < .01)

Galaal K,

Naik R,

Bristow RE,

et al(, 201",

Cocharane

>ataba!e

S#!t Re(

1431 possible

articles

(comparing

secondary

cytoreductive

surgery and

chemotherapy

with

chemotherapy

alone in women

with recurrent

epithelial ovarian

cancer)

Prolonging life No relevant studies No evidence to

determine if secondary

cytoreductive surgery

is better or worse than

chemotherapy alone in

terms of prolonging

life.

DISC$SSI!

%o!t )omen )ith adanced epithelial oarian cancer )ill $ltimatel#deelop rec$rrent di!ea!e after completion of initial treatment )ith primar#

!$rer# and ad$ant chemotherap#( Secondar# c#tored$ctie !$rer# ma# hae!$rial bene6t! in !elected patient!( 'o)eer, a n$mber of chemotherape$ticaent! are actie in rec$rrent oarian cancer and the !tandard treatment of patient! )ith rec$rrent oarian cancer remain! poorl# de6ned(

here i! no eidence from RC! to inform deci!ion! abo$t !econdar#!$rical c#tored$ction and chemotherap# compared to chemotherap# alone for)omen )ith rec$rrent epithelial oarian cancer( 4deall#, a lare randomi!edcontrolled trial or, at the er# lea!t, )ell de!ined nonDrandomi!ed !t$die! that$!e m$ltiariate anal#!i! to ad$!t for ba!eline imbalance! are needed tocompare the!e treatment modalitie!(

Secondar# c#tored$ction i! de6ned a! an attempt to re!ect or optimall#deb$l& !elected patient! )ith rec$rrent di!ea!e follo)in 6r!tDline chemotherap#(.atient! )ith platin$mDrefractor# or platin$mDre!i!tant di!ea!e are not !$itablecandidate! for !econdar# c#tored$ction, b$t !elected patient! )ith platin$mD!en!itie rec$rrent oarian cancer ma# bene6t if all macro!copic re!id$al di!ea!ecan be re!ected(

8



In conclusion, because this patient has disease free interval for about 18months, single site and also platinum sensitive, she should be oered for secondary cytoreduction

REERE!CES

1( Chi >S, %cCa$ht# @, >ia= ., et al( +$ideline! and !election criteria for

!econdar# c#tored$ctie !$rer# in patient! )ith rec$rrent, platin$mD!en!itie epithelial oarian carcinoma( Cancer( 200 10:18818(

"

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