Tumor-bowel fistula as a rare form of recurrent ovarian cancer – imaging and treatment. The pilot study

Abstract

Background. The aim of this pilot study was to evaluate the value of imaging techniques (CT and MRI) in the diagnosis of a tumor-bowel fistula as a rare form of epithelial ovarian cancer (EOC) relapse. We also performed an initial assessment of the effectiveness of the treatment of this form of relapse. Methods. The study group consisted of 8 patients with suspected platinum-sensitive recurrence in the form of a tumor/bowel fistula. All patients finished their first line of chemotherapy and subsequently showed complete remission for 6 months or more. To qualify patients for further treatment, CT and MRI were performed, which suggested the presence of a fistula between the recurrent tumor and intestine. DESKTOP study criteria were used to qualify patients for secondary cytoreduction. Second-line chemotherapy was given after secondary debulking. Results. In all patients, fistulas formed between the tumor and large bowel. On CT, the fistulas were indirectly visible. In all cases, the fistula was visible on MR images, which showed hypointensity on the T2 and T1 postcontrast sequences but did not show restricted diffusion on the diffusion-weighted imaging (DWI) sequence. Patients who were qualified for the study underwent secondary debulking with bowel resection. In all eight cases, the fistula between the tumor and surrounding organs was confirmed. During surgery, seven intestinal anastomoses and one colostomy were performed. No residual macroscopic tumor remained in seven cases (resection R0-87,5%). The progression-free survival was 8.4-22.6 months (median 13.4). In the group with cytoreduction R0, the median PFS was 15.5 months (12-22). Conclusion. In the case of relapsed EOC in patients with clinical symptoms in the form of a fistula, CT should not be the only diagnostic method, as MRI is a superior method for diagnosing fistulas. Bowel resection with simultaneous anastomosis seems to be a good and safe solution for these patients. However, an appropriate qualification for surgery is essential.