Aggressive management of recurrent ovarian cancer--the challenge of individualizing cancer therapy illustrated by a case report.
BACKGROUND
In clinical practice, treatment recommendations and the patient's wishes often diverge, facing the physician with difficult choices.


METHODS
The clinical course of a 36-year-old patient with 'platinum-refractory' ovarian cancer is reported. The patient experienced a symptomatic relapse 7 months after debulking surgery and completion of platinum-based first-line chemotherapy. As she had given birth to a son 22 months before diagnosis, she fought with outmost determination against her disease. Her husband supported her, and both asked for maximal therapy, including intensive care treatment for recurrent respiratory tract infections and total parenteral nutrition (TPN). For the patient, it was of major importance to stay with her family and make sure that her son would be able to remember his mother. Problems related to TPN and progression of disease affected her individual perception of quality of life to a much lower extent than expected and perceived by her caretakers. All professional health care providers were more than once very reluctant to continue treatment and only after extensive counseling gave in to the demand of the patient for further treatment, considering the effort futile - only to be surprised by treatment response and recovery. After 3 years of palliation, the tumor was resistant to all cytotoxic regimens and the patient died 2 months after withdrawal of chemotherapy.


CONCLUSIONS
This case report illustrates that also in the age of evidence-based medicine individualized treatment beyond proven strategies can offer patient benefit. Taking the child's development into account makes it impossible to determine the cost-benefit ratio.
Kieback
D G
DG
Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg, Germany. dki@sgyn.azm.nl
Einzmann
T
T
Labinsky
E
E
Fischer
D C
DC
Niebergall
H
H
Hasenburg
A
A
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002291:Carcinoma, Papillary / Q000188:drug therapy* / Q000523:psychology / Q000601:surgery; D003422:Critical Care / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D018447:Medical Futility; D009042:Motivation; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000523:psychology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000523:psychology / Q000601:surgery; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010289:Parenteral Nutrition, Total / Q000523:psychology; D010358:Patient Participation / Q000523:psychology; D011644:Puerperal Disorders / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology
D000970:Antineoplastic Agents