Fluorescence Diagnostics and Photodynamic Therapy in Cytoreductive Surgical Treatment of Peritoneal Carcinomatosis Patient

Abstract

Introduction. Peritoneal carcinomatosis, one of the most aggressive forms of metastasis, is recognized as a serious clinical problem. Conventional therapies, including cytoreductive surgery and systemic chemotherapy are limited in their efficacy. New approaches, involving photodynamic therapy and fluorescence diagnostics, obtain great potential for improving the outcomes of complex treatment for this category of patients. Materials and methods. The paper presents a clinical case of a female patient with peritoneal metastases of ovarian cancer complicated by small intestinal obstruction and tumor necrosis. The case demonstrates the results of implementing photodynamic technologies in combination with staged cytoreductive surgical treatment. The first stage of cytoreductive surgical intervention was mainly focused on elimination of life-threatening complications and involved fluorescence diagnostics and photodynamic therapy in order to control the completeness of cytoreduction as well as to assess the nature of suspicious tumor foci and to treat the residual tumor. The second stage of surgical treatment included completing cytoreduction under fluorescence diagnostics, and intraabdominal hyperthermic chemoperfusion. The paper evaluates the results of using fluorescence diagnostics for determining the tumor lesion of the peritoneum in order to objectify the choice of the peritonectomy volume. Results and discussion. The implementation of the described approach resulted in increased efficiency of cytoreductive intervention due to intraoperative diagnostics and targeted antitumor treatment of residual tumor foci. Assessment of the quality of life using the SF-36 survey in the postoperative period demonstrated a significant improvement in both physical and psychological components of health during three months of follow-up. Conclusion. The innovative approach, involving integration of phototheranostics into the cytoreductive surgical treatment of patients with peritoneal carcinomatosis, can potentially improve the accuracy of intraoperative diagnostics of tumor prevalence in the peritoneum and, moreover, enhance the efficiency of cytoreductive interventions. However, further clinical studies are required to fully evaluate the therapeutic potential and prove the efficacy of the proposed treatment.