1. CASE STUDY OF RECURRENT/METASTATIC OVARIAN CARCINOSARCOMA

2. Presentation  71 year old female with stage IIIB high grade ovarian malignant mixed mesodermal tumor/carcinosarcoma  S/p TAH+BSO and rectosigmoid tumor resection 01/2011  S/p 6 cycles of adjuvant Carboplatin + Taxol 02/2011 to 06/2011 without recurrence/mets  Abdominal metastasis(liver and gall bladder metastasis) in 02/2013

3. Managment issues of recurrent disease  Patient felt to be not a suitable candidate for repeat abdominal surgery given extent of liver lesions.  Patient with poor performance status at the time of recurrent disease  What would you do?

4. At Sarcoma Oncology Center  Started continuous infusional Ifosfamide, 1gm/m2/day given 14 days on 14 days off, in 03/2013.  S/p 6 cycles of CIV Ifosfamide 03/2013 to 07/2013 with excellent clinical & radiological response  Minimal toxicities, well-tolerated in this elderly patient.

5. Radiological Response to CIV Ifosfamide March 2013 CT Abdomen showing large intra-hepatic metastasis prior to Ifosfamide

6. Radiological Response to CIV Ifosfamide  July 2013 CT Abdomen showing considerable response of hepatic metastasis

7. Outcome  S/p exploratory laporotomy with right hepatic lobectomy and resection of 6.5cm & 5.3cm tumors with greater than 95% tumor necrosis on surgical pathology in 08/2013  Patient on surveillance protocol since 11/2013 with no evidence of recurrence/metastasis on most recent follow up scans from 09/2014.