Evaluation of non-completion of intraperitoneal chemotherapy in patients with advanced epithelial ovarian cancer / 부인종양

OBJECTIVE: To identify factors associated with non-completion of intraperitoneal with intravenous chemotherapy [IP/IV] in women with epithelial ovarian cancer (EOC). METHODS: This was an Institutional Review Board approved, retrospective cohort study in women with stage III EOC following optimal cytoreductive surgery (CRS) (<1 cm) followed by IP/IV chemotherapy from 2000–2016. Demographic, surgical, and oncologic variables were collected. Pearson χ2 test and 2 sample t-test evaluated for variables associated with IP/IV chemotherapy completion. Kaplan-Meier survival analysis was performed for progression-free survival (PFS) and overall survival (OS). RESULTS: Of 96 women, 71.9% (n=69) completed 6 cycles of IP/IV chemotherapy. The majority had high grade serous histology (n=82; 85.4%) and stage IIIC disease (n=83; 86.5%). Common reasons for IP/IV chemotherapy discontinuation were grade 3–4 gastrointestinal (n=10; 37.0%), neurologic (n=6; 22.2%), hematologic (n=3; 11.1%), renal toxicities (n=3; 11.1%) and port infections (n=3; 11.1%). Incidence of IP port complications was 20.8% (n=20). Port complications (48.0% vs. 11.6%; p<0.001) and hospitalization during chemotherapy (29.6% vs. 2.9%; p<0.001) were more frequent in patients who discontinued IP/IV chemotherapy. Patients who completed IP/IV chemotherapy had higher rates of home discharge following CRS (92.2% vs. 72.0%; p<0.01) and lower Eastern Cooperative Oncology Group (ECOG) score (0 vs. 1.0; p=0.04). There was no significant difference in PFS (p=0.51) nor OS (p=0.38) between the cohorts. CONCLUSION: In this series, the rate of IP/IV chemotherapy completion is high. Non-home discharge and higher ECOG status following CRS are associated with IP/IV chemotherapy non-completion and should be considered in treatment planning.

Sweet's syndrome: a cutaneous harbinger of ovarian carcinoma / 부인종양

Sweet's syndrome, or acute febrile neutrophilic dermatosis, is a condition characterized by fever, neutrophilia, erythematous skin lesions, and a dermal infiltrate consisting predominantly of mature neutrophils on histology. Sweet's syndrome is a reactive phenomenon and should be considered a cutaneous marker of systemic disease, including underlying malignancy. We present a case of a 56-year-old woman who presented with vague abdominal symptoms and a tender, erythematous rash on her extremities. Biopsy of her skin lesions revealed Sweet's syndrome. A work-up for malignancy eventually demonstrated a pelvic mass and carcinomatosis, and a diagnosis of advanced-stage papillary serous ovarian carcinoma was subsequently made. In postmenopausal women who present with Sweet's syndrome, a comprehensive evaluation for malignancy is indicated. In women with a known diagnosis of cancer, Sweet's syndrome may manifest in the detection of persistent or recurrent disease.