title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for management of recurrent/relapsed ovarian granulosa cell tumor: a single-center experience.
abstract: OBJECTIVE
  The aim of this study was to retrospectively report our experience (efficacy/morbidity) with cytoreductive surgery+hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) for the management of recurrent/relapsed ovarian granulosa cell tumors (OGCT).
  
  
  METHODS
  From 2010 to 2013, six patients underwent CRS+HIPEC. CRS was performed with standard peritonectomy procedures and visceral resections directed towards complete elimination of tumors from the abdominopelvic cavity. HIPEC was performed with cisplatin (50 mg/m²) and doxorubicin (15 mg/m²) and allowed to circulate in the abdominopelvic cavity for 90 min at 41.0-42.2°C.
  
  
  RESULTS
  Cytoreduction completeness (CC-0) was achieved in all except one patient (CC-1). Five patients had OGCT recurrences in abdomen+pelvis and one patient in abdomen only. No grade V morbidity (Clavien-Dindo classification) occurred. Two patients developed lung atelectasis, which was managed by mere chest physiotherapy (grade I). One patient developed urinary tract infection (grade II) and another patient developed pneumonia (grade II) - both of which were managed by antibiotics. One patient developed splenic bed and anterior abdominal wall collections requiring ultrasound-guided aspiration without general anesthesia (grade III). One patient developed pulmonary embolism requiring intensive care-unit management (grade IV). Four chemo-naïve patients received adjuvant chemotherapy whereas the remaining two previously chemo-exposed patients received no adjuvant therapy. All patients were alive and disease-free without proof of recurrence/relapse at 40, 32, 27, 24, 20 and 16 months. The average interval of follow-up after CRS+HIPEC was roughly 27 months (range: 16-40 months).
  
  
  CONCLUSIONS
  CRS+HIPEC appears to be an efficacious and morbidly well-tolerated therapeutic modality for recurrent/relapsed OGCT. Long-term follow-up data and further research are needed.
authors.affiliation: Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Ismail A
authors.initials: IA
authors.lastname: Al-Badawi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abu-Zaid
authors.forename: Ayman
authors.initials: A
authors.lastname: Azzam
authors.forename: Osama
authors.initials: O
authors.lastname: AlOmar
authors.forename: Hamed
authors.initials: H
authors.lastname: AlHusaini
authors.forename: Tarek
authors.initials: T
authors.lastname: Amin
mesh_terms: D000008:Abdominal Neoplasms / Q000517:prevention & control* / Q000556:secondary; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006106:Granulosa Cell Tumor / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D007430:Intraoperative Care; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery; D010386:Pelvic Neoplasms / Q000517:prevention & control / Q000556:secondary; D010533:Peritoneal Lavage; D012189:Retrospective Studies; D012529:Saudi Arabia; D062606:Tertiary Care Centers
chemical_list: D004317:Doxorubicin; D002945:Cisplatin
keywords: cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; ovarian granulosa cell tumor