Treatment of gestational choriocarcinoma and massive ascites by hypothermic intraperitoneal perfusion chemotherapy guided by ultrasound followed by cytoreductive surgery

Abstract

A 33-year-old woman with very poor health status was admitted to our hospital because she had experienced increasing abdominal distention for three months, CT examination showed a right ovarian tumor together with massive abdominal and pelvic fluid. The patient was first treated by continuous circulatory hypothermic intraperitoneal perfusion chemotherapy (HIPC) guided by B-mode ultrasound, followed by cytoreductive surgery (CRS) after her ascites was controlled and her health condition improved. She was diagnosed with gestational choriocarcinoma (GC) based on the pathological examination of the hysterectomy specimen. She is still alive with very good health today. We think it may be a good choice for a patient in very poor health with GC accompanied by massive ascites to perform HIPC guided by B-mode ultrasound firstly, followed by CRS when the ascites has relieved and the patient’s health has improved.

Safety and Effectiveness of High-Precision Hyperthermic Intraperitoneal Perfusion Chemotherapy in Peritoneal Carcinomatosis: A Real-World Study

“…Some studies demonstrated that this synergism between various cytotoxic drugs and hyperthermia is stronger at temperatures >39°C. On the other hand, the rate of small bowel heat injury increases above 43°C in humans, while HIPEC at ≤43°C appears to not influence the complication rate of HIPEC (11,24). The longer the peritoneal cavity temperature remains near 43°C, the stronger the synergism between cytotoxic drugs and hyperthermia.…”

“…The toxic effects of anticancer drugs were graded according to the National Cancer Institute Common Toxicity Criteria for Adverse Events (CTCAE) Version4.0. Effectiveness was evaluated based on ascites remission according to our previous modification of the World Health Organization criteria (22)(23)(24)(25)(26). Calculation of the total objective remission rate (ORR) was based on the remission of ascites 4 weeks after the completion of HIPEC (23).…”

“…The main problem with HIPEC is that many kinds of devices used all over the world have issues, such as poor temperature control precision, unstable perfusion rate, and complicated application. As a result, the HIPEC applicability, usefulness, and feasibility of HIPEC failed to reach clinical standards, and HIPEC is associated with a relatively high complication rate (18)(19)(20)(21)(22)(23)(24). These previous conventional devices were based on hot water-, microwave-, or radiofrequency-induced local hyperthermia, and have uncertain flow control accuracy, uncertain temperature accuracy, and 1°C to 2°C temperature control accuracy.…”

Comparative Sensing and Judgment Control System for Temperature Maintenance for Optimal Treatment in Hyperthermic Intraperitoneal Chemotherapy Surgery

“…Heat control methods (instantaneous heating) using temperature monitoring and control in HIPEC surgery include hot water and microwave (or high-frequency induction local heating thermal treatment) heating [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. These methods suffer from low precision and unstable perfusion rate during temperature control [ 27 ].…”