Advanced ovarian cancer with malignant bowel obstruction treated with multidisciplinary therapy resulting in long progression-free survival: a case report

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INTRODUCTION: Advanced ovarian cancer complicated by malignant bowel obstruction is generally considered a terminal event, especially when deemed inoperable, with an expected survival of only a few weeks. We report the case of a patient who was initially judged inoperable but who survived approximately 40 months without disease progression thanks to an active multidisciplinary approach. CASE PRESENTATION: A 76-year-old woman presented with bowel obstruction, massive ascites, and an Eastern Cooperative Oncology Group performance status of 4. Ultrasound-guided peritoneal biopsy confirmed a high-grade serous carcinoma of gynecological origin. After a multidisciplinary team discussion, the patient was deemed unsuited to surgical management. Despite this, she received total parenteral nutritional support and symptomatic control, followed by three cycles of neoadjuvant carboplatin-paclitaxel. This treatment led to a substantial reduction in her disease burden and an improvement in her performance status, permitting interval debulking surgery. The outcome of surgery was optimal cytoreduction (residual disease < 1 cm). Six additional cycles of adjuvant chemotherapy were administered (carboplatin was replaced with nedaplatin after the development of hypersensitivity). Germline breast cancer susceptibility gene 2 mutation was identified, and maintenance olaparib was initiated (300 mg twice daily, later reduced). For approximately 40 months, imaging showed good tumor control with no signs of progression, and serum cancer antigen 125 levels remained within normal limits. The patient ultimately succumbed to therapy-related myeloid neoplasms complicated by bleeding and infection, without evidence of ovarian cancer progression. CONCLUSIONS: Patients with advanced ovarian cancer who are initially diagnosed with an inoperable malignant bowel obstruction may still derive a substantial survival benefit from an integrated multidisciplinary treatment regimen. The findings of this study challenge the current negative prognosis of such patients and highlight the need for prospective studies to further explore the potential benefits of this approach.

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