title: Management of peritoneal dissemination of recurrences granulosa cell tumor of the ovary.
abstract: Recurrences of granulosa cell tumor (GCT) of the ovary often occur as disseminated peritoneal metastasis or local mass in the pelvis. Although, various treatment options including surgery with/without systemic chemotherapy and/or radiotherapy have also been reported for treatment of recurrent GCT, there is no standardized management for recurrence of this disease. Here, we report our management strategies for the patients with peritoneal dissemination of GCT. Prior to admission to our unit, four patients were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy with the diagnosis of primary adult type GCT of the ovary. They were not received adjuvant therapy because of the localized disease in the ovary and followed-up by their gynecologists until they referred to us with metastases. The median disease free survival after primary treatment was 4.7 (range, 1-9) years. All patients with peritoneal metastases from recurrent GCT were treated with cytoreductive surgery (CRS) using peritonectomy procedures and intraoperative hyperthermic intraperitoneal chemotherapy(HIPEC) using 100 mg cisplatin for 40 min at 43 °C in our unit. Postoperative complications were graded according to National Cancer Institute's Common Toxicity Criteria. No complication and no in-hospitalization mortality were experienced in all patients. The median length of operation was 3.55 (range, 2.50-5.50) hours. The median length of stay in hospital was 13(range, 12-21) days. After a median follow-up of 4(range, 1-6) years, 1 patient was died and other 3 patients were alive with no disease progression. Our study identified that recurrent adult type of GCT with peritoneal metastases could be managed with definitive CRS and HIPEC. Larger series and long term outcome data of CRS and HIPEC will be mandatory to develop standard management option in these patients.
authors.affiliation: Department of General Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan.
authors.forename: Emel
authors.initials: E
authors.lastname: Canbay
authors.forename: Haruaki
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Shozou
authors.initials: S
authors.lastname: Sako
authors.forename: Ryuwa
authors.initials: R
authors.lastname: Miyata
authors.forename: Eisei
authors.initials: E
authors.lastname: Nishino
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemura
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006106:Granulosa Cell Tumor / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D012008:Recurrence