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To the editor: Granulosa cell tumor (GCT) of the ovary is cha­ rac terized by a relatively indolent natural history with a pro­ pensity for late recurrence and long­term survival. The median time to recurrence is 4 to 6 years after the initial diagnosis [1]. Disease recurrence often presents within the pelvis as a local mass, in the retroperitoneal lymph nodes, or as disseminated peritoneal metastases [1,2]. There is no standard management for recurrent GCT. Various treatment options include surgery with/without chemotherapy and/or radiotherapy. Patients with peritoneal metastases are often considered inoperable with treatment largely directed at palliation of symptoms. Five patients with recurrent GCT with peritoneal metastases from our institution were treated with cytoreductive surgery (CRS). The mean (standard deviation) age of five women at the time of CRS was 49 (10) years. Prior to CRS, all five patients were fol ­ lowed­up after initial staging surgery performed by the gyn­ aecologic oncology surgeon. The initial staging surgery was a total abdominal hysterectomy with bilateral salpingo­oopho­ rectomy in the three patients. Two patients required opted for fertility conservation and underwent a unilateral salpingo­ oophorectomy. Due to the localized disease in the ovary, none of the patients received adjuvant treatment after the initial surgery. The median disease­free survival after primary treatment was 6 years (range, 6 to 12 years). Treatment of first recurrence involved CRS in patient one and patient three, sys temic chemotherapy in patient two, debulking surgery in patient four and systemic chemotherapy with radiotherapy in patient five. The three patients who did not undergo CRS eventually underwent CRS for management of persistent re­ current disease. The detailed summary of the patients’ clinical pathway is presented in Table 1. In total, eight cytoreductive surgeries using peritonectomy procedures were performed in five patients, of which one pa ­ tient received intraoperative hyperthermic intraperitoneal cis­ platin for 90 minutes at 42 o C. There was no in­hospitalization

Prolonged survival following maximal cytoreductive effort for peritoneal metastases from recurrent granulosa cell tumor of the ovary