992P - Bowel obstruction in ovarian and peritoneal malignancy: the Christie Hospital (Manchester, UK) experience

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Ovarian Cancer
Presenter Emma Dean
Authors E. Dean1, A. Clamp1, G. Jayson1, D. Goonetilleke2, A. Conway2, J. Hasan3
  • 1School Of Cancer And Enabling Sciences, The University of Manchester, M13 9PL - Manchester/UK
  • 2Department Of Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/UK
  • 3Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/UK

Abstract

Background

Bowel obstruction is a common clinical problem in advanced ovarian and peritoneal malignancy and is associated with a poor prognosis. We previously correlated clinical & radiological factors with outcome demonstrating that significant improvements in overall survival can be gained in a minority of patients1. Here we extend our analysis to 130 patients with biopsy-proven disease admitted between 2003-2011 with the aims of identifying patients most likely to derive benefit from palliative surgery and/or chemotherapy.

Results

The median time from diagnosis to inpatient admission with bowel obstruction was 493 days (range 0-5640). The most common histology was serous adenocarcinoma (44%). The median inpatient stay was 20 days (range 3-110); total parenteral nutrition was instigated in 22% (median duration 14 days). The majority of patients had high (> 5cm) tumour burden at multiple sites, radiological evidence of serosal disease and half developed bowel obstruction whilst receiving chemotherapy. Approximately 50% of patients presented with obstructive symptoms, but 25% presented with erratic bowel habit. Median survival following the first episode of bowel obstruction was 87 days (range 3-1754). Survival was similar between patients who underwent palliative surgery or chemotherapy (p = 0.89). Median survival for patients presenting in bowel obstruction with platinum-sensitive (PS) and platinum-resistant (PR) disease (but not chemonaïve patients) who proceeded to chemotherapy was prolonged compared with patients unsuitable for further treatment (PS 191 vs. 24 days, p < 0.0001; PR 149 vs. 50 days, p = 0.06). A feasibility trial investigating the efficacy of low residue diet and intravenous dexamethasone in the prevention and treatment of malignant bowel obstruction has been initiated.

Conclusion

Overall survival in patients with malignant bowel obstruction is poor with no significant improvement over the last decade. Bowel obstruction in patients with chemonaïve disease represents an aggressive phenotype with poor prognosis. Judicious selection of patients for surgery and/or chemotherapy can significantly increase survival.

1. ESMO Congress 2010, Milan. Poster 987P.

Disclosure

All authors have declared no conflicts of interest.