11. Guidelines for Intratumoral Injection of Chlorine Dioxide in Ovarian Cancer
11.1 Indications
11.1.1 Ovarian cancer patients unsuitable or unwilling to undergo surgical treatment.
11.1.2 Metastatic nodules in the abdominal cavity or retroperitoneal, pelvic, abdominal, and inguinal lymph nodes.
11.1.3 Distant organ metastasis.
11.1.4 Recurrence after ovarian cancer surgery or debulking surgery.
11.1.5 Patients unwilling to undergo or who failed chemotherapy/radiotherapy.
11.1.6 Normal bleeding and clotting times.
11.2 Contraindications
11.2.1 Ovarian cancer with severe ascites.
11.2.2 Cachexia.
11.2.3 Platelet count < 60×10⁹/L.
11.3 Puncture Needle and Auxiliary Instruments
Use a 23G×15.0 cm or 25G×9.0 cm puncture needle, 10–20 ml syringe, ultrasound or CT machine.
11.4 Pre-treatment Preparation
11.4.1 Complete necessary examinations:
Routine blood, urine, and stool tests.
Blood biochemistry, liver and kidney function, peripheral blood T lymphocyte subsets (CD4, CD8), and tumor markers CEA, CA125.
Bleeding and clotting time tests.
Abdominal and pelvic ultrasound, pelvic CT.
ECG.
11.4.2 Discuss the procedure with the patient, obtain consent.
11.4.3 Advise the patient to retain a moderately full bladder before and during treatment.
11.4.4 Administer intramuscular injections of 0.1g butorphanol, 1KU antihemorrhagic agent, 48mg ondansetron, and optionally 5-10mg diazepam 15 minutes before treatment.
11.5 Treatment Procedure
11.5.1 Use ultrasound or CT to locate the puncture site and determine needle depth.
11.5.2 Disinfect the skin at the puncture site, wear sterile gloves, and use a sterile drape.
11.5.3 Perform local anesthesia with 2% lidocaine solution, stabilize the skin with the left hand, and insert the needle with the right hand into the tumor center.
11.5.4 Withdraw the needle core, connect to a syringe, and inject the slow-release anticancer drug; if the ovarian tumor is cystic-solid, drain the cyst fluid before injection. For tumors ≤4 cm, use single-point injection with a dose of 30% of the tumor volume (ml); for tumors >4 cm, use multi-point injections with a similar dose based on tumor segment (cm).
11.5.5 Use ultrasound or CT to monitor drug distribution within the tumor, ensuring even dispersion to saturation.
11.5.6 After injection, remove the needle, cover the site with sterile gauze, and secure with tape.
11.5.7 Observe the patient for 5–10 minutes before transferring them back to the ward.
11.6 Post-treatment Care
11.6.1 Monitor the treatment site for redness, ulceration, or pain, and the patient for fever during the first 1–3 days. Provide anti-infective and symptomatic treatment if needed.
11.6.2 Check blood counts and liver and kidney functions on the 3rd and 7th days post-treatment.
11.6.3 Repeat treatment sessions every 7 days. At the end of the treatment course or upon discharge, assess peripheral blood T lymphocyte subsets (CD4, CD8) to evaluate immune function.