Tertiary Cytoreduction for Isolated Lymphnode Recurrence (ILNR) Ovarian Cancer in a BRCA2 Mutated Patient: Our Experience and Prevalence of BRCA 1 or 2 Genes Mutational Status in ILNR

Matteo Bruno; Manuela Ludovisi; Carlo Ronsini; Giulia Capanna; Guglielmo Stabile; Maurizio Guido

doi:10.3390/medicina59030606

Tertiary Cytoreduction for Isolated Lymphnode Recurrence (ILNR) Ovarian Cancer in a BRCA2 Mutated Patient: Our Experience and Prevalence of BRCA 1 or 2 Genes Mutational Status in ILNR

Medicina (Kaunas). 2023 Mar 19;59(3):606. doi: 10.3390/medicina59030606.

Authors

Matteo Bruno¹, Manuela Ludovisi², Carlo Ronsini³, Giulia Capanna², Guglielmo Stabile⁴, Maurizio Guido²

Affiliations

¹ Obstetrics and Gynaecology Unit, San Salvatore Hospital, 67100 L'Aquila, Italy.
² Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
³ Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
⁴ Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Department of Obstetrics and Gynaecology, 34137 Trieste, Italy.

Abstract

We report the case of a tertiary cytoreductive surgery for isolated lymph-node recurrence (ILNR) in a 54-years old Brest cancer 2 (BRCA 2) mutated patients, with a personal history of ovarian cancer previously treated elsewhere. She was admitted to our department for a suspected isolated lymph-nodal pelvic recurrence. A positron emission tomography acquisition with contrast enhanced computed tomography (PET-CT) scan revealed an increased node at the level of the right external iliac (SUV 6.9) in correspondence with the obturator nerve, which was confirmed by transvaginal ultrasound. Since the recurrence was in a single site and the patient had previously undergone three lines of chemotherapy and maintenance with Poly(ADP-ribose) polymerase (PARP) inhibitors, we decided to perform tertiary cytoreductive surgery by minimally invasive laparoscopic approach. After gradual and careful isolation of the obturator nerve, lumbo-sacral trunk and venous vessels afferent to the external and internal iliac vein, the suspected node has been removed. No intra- and postoperative complications occurred. The patient was discharged three days after procedure. We decided to quarterly follow-up; actually, after 16 months no recurrence was detected. Several studies have reported ILNR as a unique clinical disease with low growth rate and less chemosensitivity; this can lead to considered ILNR more susceptible to take advantage of surgical treatment, even in case of second or third recurrence. The BRCA mutational status seems to play a role in the decision-making process in the approach to patients with platinum sensitive relapse of ovarian cancer or in specific isolated forms of recurrence such as the hepatic one. However, data on frequency and prognostic impact of BRCA gene mutation in ILNR are very limited. In this article we investigated the role of BRCA 1 or 2 mutational status in this rare pattern of recurrence according to more recent advances in literature.

Keywords: BRCA mutated patient; isolated lymphnode recurrence; tertiary cytoreductive surgery.

Publication types

Case Reports

MeSH terms

BRCA2 Protein
Cytoreduction Surgical Procedures*
Female
Humans
Middle Aged
Mutation
Neoplasm Recurrence, Local / drug therapy
Neoplasm Recurrence, Local / genetics
Ovarian Neoplasms* / drug therapy
Ovarian Neoplasms* / genetics
Ovarian Neoplasms* / surgery
Positron Emission Tomography Computed Tomography
Prevalence

Substances

BRCA2 protein, human
BRCA2 Protein

Grants and funding

This work was supported by the Ministry of Health Rome—Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste—Italy.