Hyperthermic Intrathoracic Chemotherapy for Metastatic Ovarian Cancer

Annabelle Teng, MD, Barbara Wexelman, MD, Gary S. Schwartz, MD, Farr Nezhat, MD, Gabriel Sara, MD, Scott Belsley, MD, Faiz Bhora, MD, Cliff Connery, MD

Department of Surgery, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA (Drs. Teng, Wexelman, Schwartz, Belsley). Department of Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA (Dr. Nezhat). Department of Hematology and Oncology, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA (Dr. Sara). Department of Thoracic Surgery, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA (Drs. Bhora, Connery).

ABSTRACT

Introduction: Ovarian serous carcinoma is an aggressive malignancy, often with metastases at presentation. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has been studied as a treatment option for intraperitoneal spread of ovarian cancer. Hyperthermic intrathoracic chemotherapy, the thoracic counterpart to hyperthermic intraperitoneal chemotherapy, is emerging as a treatment option for both primary and secondary pleural cancers but has not previously been reported for treatment of ovarian metastases. The use of minimally invasive thoracoscopic techniques, including robotic assistance, for intrathoracic chemotherapy is rare. We present a case report of a patient with pleural metastasis of ovarian serous carcinoma treated with cytoreductive surgery and intrathoracic chemotherapy.

Case Description: In a 55-year-old woman who underwent a total abdominal hysterectomy and bilateral salpingooophorectomy with cytoreduction in July 2011 for ovarian cancer, a right-sided pleural effusion developed on postoperative radiographs. After chemotherapy treatment, she had a 7-month remission until positron emission tomography/computed tomography scan identified an isolated pleural metastasis. The findings of diagnostic laparoscopy were negative for occult abdominal disease. We performed robotic-assisted right-sided video-assisted thoracoscopic surgery, partial pleurectomy, and resection of pleural, diaphragmatic, mediastinal, and pericardial nodules, followed by perfusion with heated cisplatinum for 60 minutes. The surgical procedure was uncomplicated, and the patient was discharged on postoperative day 3. The serum creatinine level remained normal. The pathologic specimens showed poorly differentiated/high-grade adenocarcinoma consistent with the patient’s ovarian primary. At 10 months postoperatively, she had no evidence of early recurrence and had a normal Karnofsky performance score (100).

Conclusion: We report the first case of robotic-assisted hyperthermic intrathoracic chemotherapy to treat ovarian carcinoma. Intrathoracic chemotherapy may be an important tool in the treatment of ovarian metastases in the chest.

Key Words: ovarian carcinoma, thoracic metastases, cytoreductive surgery, perfusion hyperthermic chemotherapy, robotic assistance.

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