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Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei

Bestrahlung des ganzen Abdomens in der Palliativbehandlung des Pseudomyxoma peritonei

  • Case study
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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.

Zusammenfassung

Hintergrund

Pseudomyxoma peritonei (PMP) ist ein seltenes klinisches Syndrom, das sich durch eine muzinöse peritoneale Läsion kennzeichnet, die wiederum aus disseminierter peritonealer Adenomuzinose hervorgeht. Die Erstbehandlung besteht aus einer Kombination von zytoreduktiver Chirurgie mit hyperthermischer, intraperitonealer Chemotherapie (HIPEC). Bei Rezidiv-PMP besteht kein Konsens über die richtige Behandlung. Bei ausgewählten Patienten könnte eine erneute zytoreduktive Chirurgie mit oder ohne HIPEC zu einem besseren Ergebnis führen. Allerdings wird jedes neue Debulking minder effektiv und geht einher mit erhöhter Morbidität.

Fallbeschreibung

Wir präsentieren einen Patienten mit Darmverschluss, der durch ein Rezidiv-PMP verursacht wurde. Mit Hilfe der intensitätsmodulierten Arc-Therapie (IMAT) behandelten wir den Patienten mit einer Bestrahlung des ganzen Abdomens (WAPRT) mit einer Gesamtdosis von 33 Gy in 22 täglichen Fraktionen. Die Behandlung wurde gut vertragen und führte zu einer langzeitigen Auflösung des Darmverschlusses für einen Zeitraum von 24 Monaten.

Schlussfolgerung

Dies ist unseres Wissens nach der erste Fallbericht, der die Möglichkeit zur Behandlung des Darmverschlusses bei einem Patienten mit Rezidiv-PMP mit Hilfe von WAPRT aufzeigt. WAPRT appliziert mit IMAT sollte unserer Ansicht nach, in Analogie zum Ovariumkarzinom, als palliative Behandlungsmöglichkeit bei Patienten mit Rezidiv-PMP in Erwägung gezogen werden, besonders im Falle eines Darmverschlusses.

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Acknowledgments

The authors would like to thank Prof. M. Mareel M.D., Ph.D. for his valuable comments and suggestions to improve the quality of the manuscript.

Compliance with ethical guidelines

Conflict of interest. P. Berkovic, L. van de Voorde, G. De Meerleer, L. Delrue, B. Speleers, S. Van Belle, and K. Vandecasteele state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    P. Berkovic M.D., L. van de Voorde M.D., G. De Meerleer M.D., Ph.D., B. Speleers R.T.T. & K. Vandecasteele M.D., Ph.D.

  2. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    L. Delrue M.D., Ph.D.

  3. Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium

    S. Van Belle M.D., Ph.D.

Authors
  1. P. Berkovic M.D.
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  2. L. van de Voorde M.D.
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  3. G. De Meerleer M.D., Ph.D.
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  4. L. Delrue M.D., Ph.D.
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  6. S. Van Belle M.D., Ph.D.
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  7. K. Vandecasteele M.D., Ph.D.
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Correspondence to P. Berkovic M.D..

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Berkovic, P., van de Voorde, L., De Meerleer, G. et al. Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei. Strahlenther Onkol 190, 223–228 (2014). https://doi.org/10.1007/s00066-013-0470-7

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  • DOI: https://doi.org/10.1007/s00066-013-0470-7

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