Efficacy and safety of cell-free and concentrated ascites reinfusion therapy (CART) in gynecologic cancer patients with a large volume of ascites.

AIM: The aim of this study was to evaluate the efficacy and safety of cell-free concentrated ascites reinfusion therapy (CART) on a large amount of ascites. MATERIAL AND METHODS: Fifty-eight CART procedures were performed in nine patients with ovarian, endometrial, or cervical cancer from February 2013 to September 2014. The medical records were retrospectively reviewed for the amount of collected ascites, vital signs, and laboratory results before and after CART. RESULTS: No obvious change in the plasma protein and plasma albumin concentration was found after CART for < 5 L of ascites; however, obvious increases in both were observed in CART for ≥ 5 L of ascites (P < 0.001). The optimum cut-off value for obtaining a positive variant of plasma protein and plasma albumin after CART was 7.9 L. CART for ≥ 5 L of ascites did not increase the risk of transient water retention in the body (odds ratio = 2.2; 95% confidence interval: 0.35-13.83; P = 0.38); however, CART for ≥ 7.9 L of ascites increased the risk of water retention (odds ratio = 8.4; 95% confidence interval: 1.91-44.09; P = 0.004). The optimal cut-off value of ascites for predicting water retention due to CART was 9.2 L. CONCLUSION: Massive ascites collection in CART < 9.2 L appears to be a safe and effective treatment for improving general condition, plasma protein, and electrolytes in gynecologic cancer patients.

Glassy cell carcinoma of the uterine cervix responsive to neoadjuvant intraarterial chemotherapy.

Described as a poorly differentiated adenosquamous cancer, glassy cell carcinoma of the uterine cervix is a rare disease considered to have an extremely poor prognosis. Saitama Medical Center has been offering neoadjuvant intraarterial chemotherapy (NAC) to cervical cancer patients as a means of avoiding postoperative radiation therapy, achieving downstaging, and improving prognosis. We report a patient with glassy cell carcinoma of the uterine cervix who responded to NAC, and we discuss this case with reference to reports in the literature. A 28-year-old gravida 1, para 0 patient was referred to the Department of Obstetrics and Gynecology at Saitama Medical Center for concurrent cervical cancer at 23.5 gestational weeks. The patient was admitted to our center following the diagnosis of stage IIb cervical cancer (glassy cell carcinoma), to await fetal development, and an elective cesarean section was performed at slightly more than 29 gestational weeks. Three cycles of NAC with carboplatin (CBDCA)/etoposide/epirubicin, started 3 days after the operation, shrank the tumor remarkably. An extended radical hysterectomy was subsequently performed. It has been 6 years, to date, since the initial treatment, and our patient is alive and disease/recurrence free.