nach oben

Erschienen in:

01.02.2014 | Case study

Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei

verfasst von: P. Berkovic, M.D., L. van de Voorde, M.D., G. De Meerleer, M.D., Ph.D., L. Delrue, M.D., Ph.D., B. Speleers, R.T.T., S. Van Belle, M.D., Ph.D., K. Vandecasteele, M.D., Ph.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by mucinous peritoneal disease arising from disseminated peritoneal adenomucinosis. Primary treatment involves a combination of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). There is no consensus on the proper treatment of recurrent PMP. In selected patients, repeated cytoreductive surgery with or without HIPEC might improve outcome. However, every repeated debulking procedure becomes less effective with increased morbidity.

Case report

We present a case of a patient with intestinal obstruction caused by recurrent pseudomyxoma peritonei. We treated the patient with whole abdominopelvic radiotherapy (WAPRT) using intensity-modulated arc therapy (IMAT) to a total dose of 33 Gy, delivered in 22 daily fractions. The treatment was well tolerated and resulted in resolution of the obstruction for a period of 24 months.

Conclusion

To the best of our knowledge, we present the first case report showing the possibility of resolving intestinal obstruction with WAPRT in a patient with recurrent PMP. It is our opinion that WAPRT delivered by IMAT, in analogy with ovarian cancer, should be considered as a palliative treatment option in managing patients with recurrent PMP especially in case of obstruction.

Ayhan A, Reed N, Gultekin M et al (2011) Textbook of gynaecologic oncology, 2nd edn. Hünes Publishing, Ankara

Chua TC, Moran BJ, Sugarbaker PH et al (2012) Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol 30:2449–2456PubMedCrossRef

De Meerleer G, Vandecasteele K, Ost P et al (2011) Whole abdominopelvic radiotherapy using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease: a single-institution experience. Int J Radiat Oncol Biol Phys 79:775–781CrossRef

Dembo AJ (1992) Epithelial ovarian cancer: the role of radiotherapy. Int J Radiat Oncol Biol Phys 22:835–845PubMedCrossRef

Dowdy SC, Metzinger DS, Gebhart JB et al (2005) Salvage whole-abdominal radiation therapy after second-look laparotomy or secondary debulking surgery in patients with ovarian cancer. Gynecol Oncol 96:389–394PubMedCrossRef

Duthoy W, De Gersem W, Vergote K et al (2003) Whole abdominopelvic radiotherapy (WAPRT) using intensity-modulated arc therapy (IMAT): first clinical experience. Int J Radiat Oncol Biol Phys 57:1019–1032PubMedCrossRef

El Sayed S (1990) Pseudomyxoma peritonei treated by radiotherapy. Clin Oncol 2:120–122CrossRef

Fernandez RN, Daly JM (1980) Pseudomyxoma peritonei. Arch Surg 115:409–414PubMedCrossRef

Gough DB, Donohue JH, Schutt AJ et al (1994) Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg 219:112–119PubMedCrossRef

10.

Hinson FL, Ambrose NS (1998) Pseudomyxoma peritonei. Br J Surg 85:1332–1339PubMedCrossRef

11.

Long RT, Spratt JS Jr, Dowling E (1969) Pseudomyxoma peritonei. New concepts in management with a report of seventeen patients. Am J Surg 117:162–169PubMedCrossRef

12.

Moran B, Baratti D, Yan TD et al (2008) Consensus statement on the loco-regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol 98:277–282PubMedCrossRef

13.

Nakakura EK (2012) Pseudomyxoma peritonei: more questions than answers. J Clin Oncol 30:2429–2430PubMedCrossRef

14.

Rochet N, Sterzing F, Jensen A et al (2008) Helical tomotherapy as a new treatment technique for whole abdominal irradiation. Strahlenther Onkol 184:145–149PubMedCrossRef

15.

Ronnett BM, Yan H, Kurman RJ et al (2001) Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favorable prognosis than patients with peritoneal mucinous carcinomatosis. Cancer 92:85–91PubMedCrossRef

16.

Ronnett BM, Zahn CM, Kurman RJ et al (1995) Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei”. Am J Surg Pathol 19:1390–1408PubMedCrossRef

17.

Schag CC, Heinrich RL, Ganz PA (1984) Karnofsky Performance Status revisited: reliability, validity, and guidelines. J Clin Oncol 2:187–193PubMed

18.

Smeenk RM, Bruin SC, Van Velthuysen ML et al (2008) Pseudomyxoma peritonei. Curr Probl Surg 45:527–575PubMedCrossRef

19.

Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Pseudomyxoma peritonei. Cancer Treat Rev 33:138–145PubMedCrossRef

20.

Sugarbaker PH (2006) New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 7:69–76PubMedCrossRef

21.

Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13:176–181PubMedCrossRef

22.

Yan TD, Bijelic L, Sugarbaker PH (2007) Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms. Ann Surg Oncol 14:2289–2299PubMedCrossRef

23.

Yoon WS, Yang DS, Lee JA et al (2012) Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies. Strahlenther Onkol 188:395–401PubMedCrossRef

Titel: Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei
verfasst von: P. Berkovic, M.D.
L. van de Voorde, M.D.
G. De Meerleer, M.D., Ph.D.
L. Delrue, M.D., Ph.D.
B. Speleers, R.T.T.
S. Van Belle, M.D., Ph.D.
K. Vandecasteele, M.D., Ph.D.
Publikationsdatum: 01.02.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2014
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0470-7

Springer Medizin

Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei