# Application of CT Ultrasonography Combined with Microscopic Intraperitoneal Hyperthermic Perfusion Chemotherapy in Postoperative Treatment of Oocyst Carcinoma

Authors: Zongbao Xia; Hong Jin
Journal: Scanning
 (2022)

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## Abstract

For the postoperative treatment of oocyte carcinoma, CT and CT ultrasonography combined with microscopic intraperitoneal should be combined with peritoneal heat perfusion chemotherapy. The authors selected 50 patients who received treatment for ovarian cancer from 2017 to 2018 and divided them into two groups (observation group, 30 cases, control group, 20 cases). Cisplatin, associated with peritoneal hyperthermia, led the control group, and we monitored all patients for 1 year and provided clinical trials, lifestyle, and results for both disease group. The experimental results showed that the target reduction rate of the control group was 70%, while that of the control group was only 40%, lower than that of the control groupP<0.05. The life expectancy of the control group was higher than that of the control group, P<0.05. Nausea, vomiting, diarrhea, bone marrow compression, and constipation in the study group were slightly higher than those in the control group (35%), but there was no significant difference between the two groups (P>0.05). Chemotherapy combined with intraperitoneal infusion of loplatin has no side effects, helps improve survival, and can be used in a variety of clinical trials.


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## Body

## 1. Introduction

Disease and mortality rates were higher than and lower than for uterine and endometrial cancers. The disease poses a serious threat to the physical and mental health of countless women. According to statistics, 295,000 new cases of ovarian cancer are reported worldwide each year, and about 185,000 people die from ovarian cancer. In 2018, the American journal CA published statistics on ovarian cancer. In 2019, 23,000 new cases and 15,000 deaths are expected nationwide. Over the past 10 years, the incidence of ovarian cancer in Mongolia has increased by 30 percent and the death rate by 18 percent. Recent statistics show that the incidence of ovarian cancer is high, and monitoring the development of ovarian cancer and improving treatment is of great significance to support women’s lives, physical health, and social development [1]. There are many types of ovarian cancer, of which above skin cancer is the most common, accounting for more than 70 percent of all ovarian cancers. Ovarian cancer is unique in that there are no specific symptoms in the early stages of the disease, and 70-80% of patients miss the best time to seek treatment to advance to a higher level. Ovarian cancer is associated with chronic metastasis. There is no good treatment. The 5-year survival rate is 20%~30%. Ovarian death is the leading cause of death in women. Therapy has become a hot topic in the research community, especially when it comes to ovarian cancer [2].The main feature of advanced ovarian cancer is tumor metastasis, and the main route of metastasis is in the pelvis and abdomen, which makes the cancer cells difficult to control, and the survival rate of patients is low. Many researchers seek to study ways to control disease progression and prolong patients’ lives. With the development of medical devices, CRS has become an important part of the treatment of ovarian cancer, eliminating as much pelvic and abdominal cancer as possible, reducing the residual tumor diameter to less than 1 cm, and even eliminating macroscopic cancer cell damage. Although CRS can maximize the increased risk of injury in ovarian cancer patients, the combination of CRS-based systemic chemotherapy in ovarian cancer patients can improve the treatment effect of ovarian cancer patients [3]. However, due to the limited penetration of chemotherapy drugs into the meridians of the whole body, the ability to kill cancer cells in the peritoneal cavity is not strong, so after systemic chemotherapy, tumor lesions and cancer cells may remain in the peritoneal cavity. Patients with severe ascites associated with an increased risk of postoperative cancer recurrence are affected by combined treatment outcomes, and long-term survival remains suboptimal. The effectiveness of local abdominal therapy (Figure 1) is closely related to the prognosis of advanced ovarian cancer. Therefore, optimizing local peritoneal therapy and controlling ascites is an effective way to improve the therapeutic effect of ovarian cancer [4].Figure 1
Intraperitoneal hyperthermic perfusion chemotherapy.


## 2. Literature Review

Lee et al.’s study, ovarian cancer is considered one of the three most common cancers in pregnant women. Ovarian cancer cannot be diagnosed early and often develops because of the location of the ovaries and the absence of specific symptoms early on. In the absence of effective treatment for heart disease, death can affect a woman’s quality of life and well-being [5]. In Kim et al.’s study, CRS and systemic platinum and paclitaxel chemotherapy improve prognosis and survival in ovarian cancer patients but are currently accepted as adjuvant therapy for advanced ovarian cancer surgery. Despite the use of paclitaxel-based intravenous chemotherapy, the long-term survival of ovarian cancer patients after this procedure remains poor, and most ovarian cancer patients eventually die of recurrence [6]. In Alberti et al.’s study, the main approach to ovarian cancer metastasis is considered to be the removal of implants on various organ surfaces in the abdominal cavity, wide-abdominal implants, residual disease at the site of metastatic implantation, and free cancer cells, which focuses on improving the treatment outcomes of advanced ovarian cancer [7]. In Hu et al.’s study, drugs are not considered to be fully effective because sunlight and peritoneal occlusion inhibit the spread of anticancer chemotherapeutic drugs to the cancer, resulting in reduced effective concentrations of chemotherapeutic drugs reaching tumor tissue. The remnants of the metastatic implantation site help repair damage and destroy cancer-free cells [8]. Intraperitoneal hyperthermia, studied by Gray and Haworth, has been shown to improve ascites control and quality of life in patients with epithelial ovarian cancer [9]. In Yiu et al.’s study, intravenous chemotherapy with paclitaxel has been shown to combine cisplatin with peritoneal hyperthermia, and the treatment of ovarian cancer may extend disease-free life. Therefore, it can be concluded that intraperitoneal hyperthermic perfusion therapy for ovarian cancer helps control ascites, destroys pelvic peritoneal cancer cells, and significantly improves the effect of destroying cancer cells [10]. Therefore, Matrone et al. suggest that localized cancers are more accessible to chemotherapeutic drugs if the drugs can be injected directly into the abdomen, which is an effective treatment to improve the effect of advanced peritoneal therapy and cancer metastasis [11]. In Wang’s study, CRS combined with intraperitoneal hyperthermic perfusion therapy is more serious after 7 to 10 days, the main reason is that the body temperature changes greatly when the body’s stress response is severe due to intraperitoneal perfusion therapy. This increases the incidence of adverse reactions and their complications [12]. Horry et al. have shown that peritoneal hyperthermia is effective in the treatment of peritoneal hyperthermia because it effectively eliminates symptoms of ovarian cancer, prolongs patient survival, improves patient quality of life, and reduces complications and adverse reactions. This is considered the best treatment for ovarian cancer [13] .


## 3. Experimental Analysis

### 3.1. Experimental Subjects

There were 50 inpatients with ovarian cancer in our hospital from 2017 to 2018, and 20-30 patients were randomly examined. In the control group, there were 11 cases of cystadenocarcinoma, 6 cases of mucositis, and 4 cases of lymphoma. According to FIGO staging procedure, there were 3 cases of endometrial leukemia, 10 cases of stage III, and 10 cases of stage IV [14]. The age group was 45-669 years old, and the mean age was 53.5±38 years old. The pathological group included plasma cystadenocarcinoma, mucous membrane carcinoma, lymphocytic carcinoma, and endometrioid carcinoma 8, 6, 5, and 3. Under the Fi-Go programme, 10 cases were registered in phase III and 8 in phase IV. There were no differences in age, type of disease, or level of treatment between the control groups. P>0.05 can be compared [15, 16].


### 3.2. Experimental Method

#### 3.2.1. Included and Excluded Procedures

Selection criteria were as follows: (1) All patients were diagnosed with ovarian cancer by postoperative pathology, imaging, and gynecological examination; (2) the age of the patients was over 45 years old; and (3) the patients should voluntarily cooperate with the research activities and sign the informed consent. Inclusion criteria were as follows: (1) Patients with severe heart, brain, liver, renal failure, or other cancers; (2) patients with contraindications to surgery; (3) patients with mental illness or cognitive impairment; (4) not signed patients who do not cooperate with the consent form for research activities specified in this guideline; and (5) patients diagnosed with stage I and II ovarian cancer [17].


#### 3.2.2. Treatment

Patients in the control group were given carboplatin AUC (100 mg) and combined injection of 135 mg/m2 paclitaxel (30 mg), once every three days. Patients were treated once a week for up to six hours. The control group was provided with chemotherapy and carboplatin AUC administration (100 mg) combined with 135 mg/m2 paclitaxel (30 mg) intravenous infusion. Patients were treated once for 3 weeks and continued for 6 times as a course of treatment. Patients were directly assisted with chemotherapy (same below). On this basis, patients in the observation group were treated with cisplatin intraperitoneal thermal perfusion. On the first day of intraperitoneal perfusion chemotherapy, paclitaxel was intravenously injected, and 75 mg/m2 cisplatin (20 mg) was intraperitoneally injected on the second day for continuous treatment [18]. Paclitaxel was reapplied on day 8. If the patient had ascites, abdominal heat infusion should be started only after ascites had been drained.


#### 3.2.3. Observation Indicators

The clinical effects of the two groups of patients were compared: complete remission in CR means that the patient’s injury has disappeared for more than 1 month; PR partial remission means that the patient’s injury has been significantly eliminated; stable SD injury indicates that the patient’s injury still exists; and PD lesions indicate that these conditions are in treatment and were not satisfied. The staff of our hospital followed up the patients for one year, accurately recorded the survival time and side effects of the two groups of patients, and used the Karnofsky scale to evaluate patients’ higher quality of life [19, 20].


### 3.3. Statistical Methods

Statistical analysis was performed by SPSS 20.0 software. The number of data was expressed asn and %, and the measured data was expressed as the mean standard deviation of brothers, based on which T tests were performed. P<0.01 indicated statistically significant difference.


### 3.4. Analysis of Results

As shown in Table1, the target response rate was 70% higher in the control group, x2=4.8, and P<0.05.Table 1
Comparison of treatment between the two groups (n=20, cases/%).
GroupCRPRSDPDObjective response rateObservation group2116169.0Control group07743.0As shown in Table2, the mean values of negative results were similar between the two groups, there was no significant difference between the two groups, x2=0.265, and P>005.Table 2
The adverse reactions between the two groups were compared (n=30, %).
GroupFeel sick and vomitDiarrheaConstipateMyelosuppressionIncidenceObservation group313234.0Control group221131.0The mean 1-year and 2-year life expectancy of the experimental group was 91.18% and 82.35%, respectively, higher than that of the control group (70.59% and 55.88%,P<0.05) (see Table 3).Table 3
Comparison of survival between the two groupsn%.
GroupExample numberSurvival in 1 year2 years of survivalThe research group343128Anchoring group342419X24.6605.581P0.0310.018The incidence of adverse events in the study group was 28.57%. Negative cases accounted for 25% in the user group, and there was no significant difference (P>0.05) (see Table 4).Table 4
Comparison of the incidence of adverse events between the two groupsn%.
GroupDiarrheaBone marrow transplantNausea and vomitingAstrictionTotal incidenceThe research group133227.56%Anchoring group221224.00%The PFS of control group and control group were (9.59±6.50) months and (9.30±4.38) months, respectively. As shown in Figure 2, there was no significant difference between the control panels in terms of PFS and operating system (P>0.05).Figure 2
Kaplan-Meier survival curve was used to compare the overall survival rates between the two groups.


## 3.1. Experimental Subjects

There were 50 inpatients with ovarian cancer in our hospital from 2017 to 2018, and 20-30 patients were randomly examined. In the control group, there were 11 cases of cystadenocarcinoma, 6 cases of mucositis, and 4 cases of lymphoma. According to FIGO staging procedure, there were 3 cases of endometrial leukemia, 10 cases of stage III, and 10 cases of stage IV [14]. The age group was 45-669 years old, and the mean age was 53.5±38 years old. The pathological group included plasma cystadenocarcinoma, mucous membrane carcinoma, lymphocytic carcinoma, and endometrioid carcinoma 8, 6, 5, and 3. Under the Fi-Go programme, 10 cases were registered in phase III and 8 in phase IV. There were no differences in age, type of disease, or level of treatment between the control groups. P>0.05 can be compared [15, 16].


## 3.2. Experimental Method

### 3.2.1. Included and Excluded Procedures

Selection criteria were as follows: (1) All patients were diagnosed with ovarian cancer by postoperative pathology, imaging, and gynecological examination; (2) the age of the patients was over 45 years old; and (3) the patients should voluntarily cooperate with the research activities and sign the informed consent. Inclusion criteria were as follows: (1) Patients with severe heart, brain, liver, renal failure, or other cancers; (2) patients with contraindications to surgery; (3) patients with mental illness or cognitive impairment; (4) not signed patients who do not cooperate with the consent form for research activities specified in this guideline; and (5) patients diagnosed with stage I and II ovarian cancer [17].


### 3.2.2. Treatment

Patients in the control group were given carboplatin AUC (100 mg) and combined injection of 135 mg/m2 paclitaxel (30 mg), once every three days. Patients were treated once a week for up to six hours. The control group was provided with chemotherapy and carboplatin AUC administration (100 mg) combined with 135 mg/m2 paclitaxel (30 mg) intravenous infusion. Patients were treated once for 3 weeks and continued for 6 times as a course of treatment. Patients were directly assisted with chemotherapy (same below). On this basis, patients in the observation group were treated with cisplatin intraperitoneal thermal perfusion. On the first day of intraperitoneal perfusion chemotherapy, paclitaxel was intravenously injected, and 75 mg/m2 cisplatin (20 mg) was intraperitoneally injected on the second day for continuous treatment [18]. Paclitaxel was reapplied on day 8. If the patient had ascites, abdominal heat infusion should be started only after ascites had been drained.


### 3.2.3. Observation Indicators

The clinical effects of the two groups of patients were compared: complete remission in CR means that the patient’s injury has disappeared for more than 1 month; PR partial remission means that the patient’s injury has been significantly eliminated; stable SD injury indicates that the patient’s injury still exists; and PD lesions indicate that these conditions are in treatment and were not satisfied. The staff of our hospital followed up the patients for one year, accurately recorded the survival time and side effects of the two groups of patients, and used the Karnofsky scale to evaluate patients’ higher quality of life [19, 20].


## 3.2.1. Included and Excluded Procedures

Selection criteria were as follows: (1) All patients were diagnosed with ovarian cancer by postoperative pathology, imaging, and gynecological examination; (2) the age of the patients was over 45 years old; and (3) the patients should voluntarily cooperate with the research activities and sign the informed consent. Inclusion criteria were as follows: (1) Patients with severe heart, brain, liver, renal failure, or other cancers; (2) patients with contraindications to surgery; (3) patients with mental illness or cognitive impairment; (4) not signed patients who do not cooperate with the consent form for research activities specified in this guideline; and (5) patients diagnosed with stage I and II ovarian cancer [17].


## 3.2.2. Treatment

Patients in the control group were given carboplatin AUC (100 mg) and combined injection of 135 mg/m2 paclitaxel (30 mg), once every three days. Patients were treated once a week for up to six hours. The control group was provided with chemotherapy and carboplatin AUC administration (100 mg) combined with 135 mg/m2 paclitaxel (30 mg) intravenous infusion. Patients were treated once for 3 weeks and continued for 6 times as a course of treatment. Patients were directly assisted with chemotherapy (same below). On this basis, patients in the observation group were treated with cisplatin intraperitoneal thermal perfusion. On the first day of intraperitoneal perfusion chemotherapy, paclitaxel was intravenously injected, and 75 mg/m2 cisplatin (20 mg) was intraperitoneally injected on the second day for continuous treatment [18]. Paclitaxel was reapplied on day 8. If the patient had ascites, abdominal heat infusion should be started only after ascites had been drained.


## 3.2.3. Observation Indicators

The clinical effects of the two groups of patients were compared: complete remission in CR means that the patient’s injury has disappeared for more than 1 month; PR partial remission means that the patient’s injury has been significantly eliminated; stable SD injury indicates that the patient’s injury still exists; and PD lesions indicate that these conditions are in treatment and were not satisfied. The staff of our hospital followed up the patients for one year, accurately recorded the survival time and side effects of the two groups of patients, and used the Karnofsky scale to evaluate patients’ higher quality of life [19, 20].


## 3.3. Statistical Methods

Statistical analysis was performed by SPSS 20.0 software. The number of data was expressed asn and %, and the measured data was expressed as the mean standard deviation of brothers, based on which T tests were performed. P<0.01 indicated statistically significant difference.


## 3.4. Analysis of Results

As shown in Table1, the target response rate was 70% higher in the control group, x2=4.8, and P<0.05.Table 1
Comparison of treatment between the two groups (n=20, cases/%).
GroupCRPRSDPDObjective response rateObservation group2116169.0Control group07743.0As shown in Table2, the mean values of negative results were similar between the two groups, there was no significant difference between the two groups, x2=0.265, and P>005.Table 2
The adverse reactions between the two groups were compared (n=30, %).
GroupFeel sick and vomitDiarrheaConstipateMyelosuppressionIncidenceObservation group313234.0Control group221131.0The mean 1-year and 2-year life expectancy of the experimental group was 91.18% and 82.35%, respectively, higher than that of the control group (70.59% and 55.88%,P<0.05) (see Table 3).Table 3
Comparison of survival between the two groupsn%.
GroupExample numberSurvival in 1 year2 years of survivalThe research group343128Anchoring group342419X24.6605.581P0.0310.018The incidence of adverse events in the study group was 28.57%. Negative cases accounted for 25% in the user group, and there was no significant difference (P>0.05) (see Table 4).Table 4
Comparison of the incidence of adverse events between the two groupsn%.
GroupDiarrheaBone marrow transplantNausea and vomitingAstrictionTotal incidenceThe research group133227.56%Anchoring group221224.00%The PFS of control group and control group were (9.59±6.50) months and (9.30±4.38) months, respectively. As shown in Figure 2, there was no significant difference between the control panels in terms of PFS and operating system (P>0.05).Figure 2
Kaplan-Meier survival curve was used to compare the overall survival rates between the two groups.


## 4. Discussion

Surgical resection is very common in the treatment of ovarian cancer and has also been found in long-term clinical practice. However, in ovarian cancer patients, surgery may achieve some therapeutic effect, but it is not possible to completely eliminate the cancer. There are still many patients with tissue, lymph nodes, and postoperative recurrence [21] . Therefore, ovarian cancer patients should undergo surgical removal of the ovaries with appropriate chemical and physical methods as adjuvant therapy. In the past, clinicians administered intravenous chemotherapy to patients, but this treatment is prone to adverse consequences, resulting in patient intolerance, serious decline in patient compliance, and many patients abandoning treatment. With the continuous development and application of medical technology, more and more doctors are researching and using peritoneal chemotherapy, making full use of long-term care and high-concentration local drugs to chemotherapy patients. Direct contact with the injured part of the patient reduces the risk of adverse patient reactions and ensures high safety. Some scholars have shown in the results of their research reports the use of hyperthermia that can kill tumor cells in patients, so the combined application of hyperthermia and chemotherapy for tumor patients can help to enhance the effect of treatment, control the patient’s lesions, and further reduce the volume of the lesions, it has a very important application value for the treatment and recovery of patients [22, 23].The incidence of ovarian cancer has hidden characteristics, and the disease will spread and metastasize to the abdominal cavity in the early stage, and at the time of diagnosis, it has generally developed to the middle and late stages, and most of them are treated with chemotherapy. Ovarian cancer is highly malignant and has a low cure rate, and in clinical practice, comprehensive surgical treatment is mainly used, but surgery cannot completely stop the seeding and dissemination of intra-abdominal cancer cells, so the postoperative recurrence rate is high. Chemotherapy cannot have a good inhibitory effect on tumor proliferation and implantation and cannot reduce ascites [24]. The main spread of ovarian cancer is to spread to adjacent organs or implant in the parietal and visceral peritoneal surfaces. Therefore, the direct infusion of chemotherapeutic drugs can effectively increase the local drug concentration and improve the ability to kill tumors. Paclitaxel and cisplatin are the most commonly used chemotherapy regimens in clinical practice, and paclitaxel is a cell cycle-specific drug that can effectively accelerate the polymerization of tubulin and inhibit its depolymerization, thereby affecting tumor proliferation. Cisplatin is the first-generation platinum preparation and is the most widely used drug in intraperitoneal hyperthermia. Through intraperitoneal hyperthermic perfusion of cisplatin, free cancer cells in the abdominal cavity can be killed and eliminated, and the rate of liver metastasis and postoperative recurrence can be reduced. At the same time, because the drug does not directly enter the body’s circulation, there is less damage to the kidneys and a lower incidence of adverse reactions in the digestive tract. Since the new blood vessels in the tumor do not respond to heat, when the temperature reaches >40°C, the cancer cells will gradually die, and the critical temperature of general tissues is about 45.7-47.0°C. Therefore, hyperthermic perfusion therapy can effectively stimulate the body’s immunity and achieve the effect of antitumor. Hyperthermic perfusion chemotherapy can improve the internal blood supply of the body and accelerates the accumulation and response of chemotherapy drugs and reversal of drug resistance in ovarian cancer cells. Elevated temperature can also make cancer cells generate nitric oxide (NO), increase cytotoxicity, and enhance the expression of some genes under the action of cisplatin [25].


## 5. Conclusion

Ovarian cancer is the most common cause of the disease, but it spreads early without any symptoms and is usually diagnosed in the secondary and later stages of the cancer. Currently, cancer treatment is relatively low, surgery is an important choice, but does not affect the spread of breast cancer, and surgery cure rate is very high. Postoperative chemotherapy is therapeutic, but inhibition is unclear. Increasing the local concentration of loplatin is more effective in stopping the spread of cancer because loplatin penetrates the abdominal cavity, circulates directly into the gastrointestinal tract, and improves the ability to fight cancer. In this study, patients in the user group received the same treatment and patients in the study group received abdominal hyperthermia. The incidence of adverse events and subsequent survival was compared between the two groups. The results showed that the incidence of adverse events was 28.57%. The incidence of adverse events in control group was 25%, and there was no significant difference (P>0.05) and (P<0.05). In conclusion, loplatin combined with peritoneal hyperthermia in the treatment of ovarian cancer will not cause adverse reactions compared with physicians but also play an important role in improving the quality of life and survival rate of patients and general treatment.At present, studies have found that the application of intraperitoneal hyperthermic perfusion and basic chemotherapy has application advantages, but there are few relevant research data, and there is a lack of application research on tumor cytoreduction combined with intraperitoneal hyperthermic perfusion chemotherapy. Ovarian cancer treatment is feasible. Based on the current research status analysis, cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy will become a hot topic in future research. Research and analysis on this can achieve breakthrough research results and provide a reference for the clinical treatment of advanced ovarian cancer.



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