Case presentation
A 56-year-old female visited a doctor on October 23, 2013 due to chest tightness and cough. Chest X-ray examination showed right pleural effusion and parallel puncture. A small number of cancer cells were found in pleural fluid smear, which tended to adenocarcinoma. Blood Ca125>600 IU/ml. Abdominal CT on October 29, 2013 showed cystic and solid mass in bilateral adnexal areas of pelvis, which was considered to be derived from ovarian malignant tumor with possible large peritoneal metastasis. A large amount of pelvic effusion was considered metastatic. 1 course of intravenous chemotherapy TC regimen (Paclitaxel 210mg+ carboplatin 500mg). PET/CT examination on November 4, 2013 showed bilateral ovarian MT with multiple metastases to mesentery and pelvic floor peritoneum, and massive effusion in right pleural cavity and abdominal pelvis. On November 22, 2013, total hysterectomy + omentectomy + diaphragmatic incision + pleural exploration + diaphragmatic repair was performed. Postoperative pathology: (left ovary) serous papillary adenocarcinoma, high grade, tumor size 8*7*7cm, left fallopian tube not involved,(right ovary) serous papillary adenocarcinoma, high grade, tumor size 6.5*5* 2.5 cm, right fallopian tube not involved, send another (Upper abdominal tumor, left pararectal tumor, right pararectal tumor) See cancer involvement. Send separately (liver surface nodule, uterus rectal fossa peritoneum, left ovarian blood vessel, greater omentum) No cancer involvement;(uterus) endometrium showed proliferation-like morphology;(cervix) chronic inflammation. Tumor cells: ER(+++) PR(-) P53(++) Her2/neu(1+) VEGF(++) WT1(+) β-Catenin(++) Ki67(+)60% Bcl-2(+) bax(+) MDR(+) TOPOII(individual +) GSTn(+) P27(++) CyclinD1(+) AgNOR1-3/The patients voluntarily enrolled in the phase II clinical trial of intraperitoneal chemotherapy for advanced epithelial ovarian cancer, and were randomly assigned to intraperitoneal chemotherapy group, who received 4 times of thoracic intraperitoneal infusion chemotherapy from November 27, 2013 to December 18, 2013, respectively. The regimen: cisplatin combined with etoposide. The chemotherapy process was smooth. After chemotherapy, III degree bone marrow suppression occurred. After the last chemotherapy, blood Ca125: 6.86IU/ml.
The patient received postoperative adjuvant chemotherapy from January 2, 2014 to May 9, 2014, totaling 6 courses (Docetaxel 80mg+ carboplatin 600mg,ivgtt, q3w). From December 2016 to July 2021, traditional Chinese medicine was given in our department for anti-recurrence and metastasis treatment, and traditional Chinese medicine intravenous injection: Aidi injection was given.(Guizhou Yibai Pharmaceutical Co.Ltd, Chinese medicine approval number: Z52020236)100ml+ compound Sophora flavescens injection (Shanxi Zhendong Pharmaceutical Co.Ltd, Chinese medicine approval number: Z140021230)20ml,qd,regular reexamination showed no evidence of recurrence and metastasis.
On July 8, 2021, PET/CT reexamination showed soft tissue nodules near the blood vessels in the left pelvic wall and increased FDG metabolism. It was considered that the metastatic tumor might be large (about 11 mm x 9 mm x 10mm)(a).The rest showed no abnormality. Blood: Ca125: 4.23 U/ml. From July 16, 2021 to October 18,2021,5 courses of first-line TC chemotherapy (albumin paclitaxel 200mg d1, d8+ carboplatin 500 mg d1 ivgtt, q3w) combined with traditional Chinese medicine injection: Aidi injection 100ml+ Kushen injection 20 ml, qd. On September 16, 2021,pelvic MR was evaluated as CR after 3 courses of chemotherapy(b),Blood: Ca125: 4.23 U/ml. Grade III bone marrow suppression and liver dysfunction occurred after chemotherapy, so the sixth course of chemotherapy was suspended, and the efficacy evaluation during the reexamination was CR. From October 15,2021 to October 30, 2023,the patient continued to receive a total of 10 courses of traditional Chinese medicine antitumor therapy (Aidi 100ml+ Kushen Injection 20ml qd), and the reexamination evaluation during the period was CR(c).The last review was October 31,2023.The imaging examination of our hospital was CR(d),blood Ca125:10.1U/ml.