Isolated incisional metastases after intraperitoneal radioactive chromic phosphate therapy for ovarian carcinoma

Article Abstract:

Phosphorus-32 (P-32) is a radioactive isotope of the common element phosphorus. This isotope emits beta particles, which have a very limited ability to penetrate living tissue. For many years, oncologists have put this characteristic to use in the prevention of metastases from ovarian cancer. The majority of metastatic tumors that develop from ovarian cancer occur in the peritoneal cavity. Radioactive chromic phosphate may be injected into the peritoneal cavity after the surgical removal of the cancerous tissue. The radiation from the solution affects only the innermost layer of tissue in the peritoneum, including any microscopic colonies of cancer cells that might be present. Since the beta particles do not penetrate tissue well, radiation exposure of the rest of the body is kept to a minimum. In this way, the exposure of the metastatic cells can be maximized while minimizing the adverse side effects of radiation. The technique is effective, and most patients who do develop metastases following this treatment do so outside the peritoneal cavity. The authors present two cases which illustrate an unusual form of cancer recurrence and demonstrate a limitation of intraperitoneal P-32 radiotherapy. One patient developed recurrent cancer in the wall of the abdomen, within the surgical scar. The other patient developed recurrent cancer in the healing tract through which a catheter had been inserted into the peritoneal cavity. In both cases, it is presumed that unseen cancer cells from the peritoneal cavity contaminated the surgical wounds. Clearly, live cancer cells are often present in the peritoneal cavity even in the absence of visible metastatic disease. However, the cancer cells in the peritoneum are destroyed by the P-32 radiotherapy, while the limited penetration of the beta particles prevents them from reaching the cancer cells inadvertently relocated to the abdomen wall. Such recurrences are rare, but they should not be overlooked as a possibility. Fortunately, early recognition of these recurrences apparently permits successful treatment; in both cases, the patients remain alive with no evidence of cancer after treatment for their unusual recurrences. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Radioisotopes

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Adjuvant intraperitoneal chromic phosphate therapy for women with apparent early ovarian carcinoma who have not undergone comprehensive surgical staging

Article Abstract:

Surgery is the main form of treatment of ovarian cancer. In about one third of all cases, it appears at the time of surgery that the disease has not spread beyond the pelvic area. However, even with Stage I ovarian cancer, the survival of patients receiving only surgery and radiation to the pelvic area is no more than 70 percent. It is now appreciated that many small hidden metastatic colonies of cancer cells are likely to have spread to the upper abdomen and to lymph nodes behind the abdominal cavity. Ideally, all patients with ovarian cancer might receive extensive examination for signs of cancer spread at the time of primary surgery. However, this is not often done, and the clinician must decide how to treat the case when the extent of tumor spread is undetermined. One method has been to inject a solution containing radioactive phosphorus-32 into the abdominal cavity. The rationale is that this radioactive solution penetrates the many potential hiding places of cancer cells. A study was conducted to evaluate the effectiveness of this treatment in the prevention of relapse after surgery for ovarian cancer. The cases of 49 patients with Stage I or Stage II ovarian cancer were reviewed. Nine of the 42 women with Stage I cancer suffered relapses, as did three of seven women with Stage II cancer. These relapses suggest that radioactive phosphorous is not sufficient to prevent relapses. Comprehensive patient evaluation during surgery should be conducted to determine which patients should receive more aggressive chemotherapy. However, if a comprehensive evaluation has not been conducted, then the physician should use aggressive chemotherapy in all cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Isotopes, Chemotherapy, Phosphorus, Phosphorus (Chemical element)

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