At Airomedical, we often support patients who have already been through several lines of treatment and need a fresh expert opinion from abroad. One of these cases was K. Yevgenia, a 61-year-old patient from Canada with metastatic ovarian cancer and peritoneal carcinomatosis.

Her medical history was complex. She had recurrent platinum-resistant high-grade serous ovarian cancer with disease spread in the abdominal cavity. In 2019, she underwent extensive surgery, including omentectomy, diaphragm resection, total abdominal hysterectomy with bilateral salpingo-oophorectomy, and right hemicolectomy. Despite this major intervention, the disease returned in 2021, and she continued with chemotherapy.

Prof. Dr. med. Karl Reinhard Aigner Over time, the cancer progressed further, and the peritoneal carcinomatosis worsened. In addition to the tumor burden itself, she developed serious complications that made the situation even more difficult. In June 2023, she was treated for an abdominal wall abscess. During this period, she required interventional radiology drainage procedures, drain upsizing, antibiotic therapy with ciprofloxacin and daptomycin, and later drain removal.

At the end of August 2023, she presented again with a new opening above the fistula site with purulent drainage. Her CT scan showed that some of the previously seen abdominal wall collections had decreased in size, but the enterocutaneous fistula remained unchanged. The intra-abdominal collection near the fistulous tract also persisted. At the same time, the scan showed a marginal increase in peritoneal nodules and signs of partial or low-grade bowel obstruction in the right anterior pelvis. Culture results grew VRE and Enterobacter cloacae.

Because of the active fistula and infection, her chemotherapy had to be interrupted. She was also denied fistula closure at that stage. This created a difficult situation: the patient still needed oncological treatment, but the local complication made continuation of standard therapy impossible.

Our team organized several expert second opinions from the Airomedical network to help the patient and her family better understand what options were still available. Her case was reviewed by Prof. Dr. med. Karl R. Aigner, Prof. Dr. med. Helmut Friess, and Prof. Dr. med. Plamen Staikov - all experienced specialists in complex oncological cases.

After evaluating the available opinions, the most promising treatment concept came from Prof. Dr. med. Karl R. Aigner at Medias Clinic Burghausen in Germany.

Prof. Aigner’s assessment focused not only on the fistula itself, but also on the underlying cause. In advanced ovarian cancer with extensive peritoneal metastases, fistulas can develop because the viability of the bowel is compromised by tumor spread. In such cases, fistula closure alone is often not enough, since the same problem may recur if the metastatic burden is not reduced first.

Isolated Hypoxic Abdominal Perfusion Based on this, he recommended a staged treatment strategy. The plan was to start with two cycles of regional chemotherapy in the form of abdominal perfusion. The goal was to reduce the peritoneal tumor burden first and then proceed with fistula closure under better conditions. This approach was considered more suitable than further systemic chemotherapy, especially given the limited effectiveness of prior treatment and the impact on the patient’s quality of life.

For the patient and her family, this recommendation offered something they had been missing: a structured plan tailored to the complexity of the case.

Airomedical then arranged the treatment journey as a full package. This included both the medical coordination and transportation logistics, allowing the patient to focus on treatment rather than the organizational burden of international care. In cases like this, where time, energy, and physical condition are already limited, having all parts of the journey organized in advance can make a major difference.

This case reflects a situation we see regularly in international oncology care. Patients with advanced disease are often not only facing cancer progression, but also complications that interrupt or limit standard treatment options. In such situations, access to several experienced specialists from different centers can help identify options that may not be immediately available locally.

For Yevgenia, the path from Canada to Germany was based on exactly that: the need for a new treatment strategy in a highly challenging clinical situation. Through Airomedical, she received several expert opinions, selected the option that best matched her case, and was able to travel for a planned treatment program at Medias Clinic Burghausen.

Her story is an example of how international second opinions and coordinated cross-border care can help patients with complex oncological conditions access new possibilities when standard pathways have reached their limits.

Patient Stories