Octreotide in the Management of Bowel Obstruction in Terminal Ovarian Cancer

Intestinal obstruction is a common and distressing clinical complication in ovarian cancer. The aim of our study was to assess vomit control in terminal ovarian cancer patients with inoperable gastrointestinal obstruction, using a symptomatic pharmacological treatment with octreotide which obviates the need for nasogastric tube placement. We studied 13 patients, all of whom had advanced ovarian cancer FIGO stage IIIc. Seven patients were treated in the Gynecology Department of S. Raffaele Hospital, at the University of Milan, and 6 were managed in the University of Varese Hospital. Octreotide was administered at doses starting with 0.3 up to 0.6 mg (mean 0.44 mg) a day by subcutaneous bolus or continuous infusion. Octreotide controlled vomiting in all cases to grade 0 on the WHO emesis scale. Complete relief of symptoms was achieved within 3.07 days (range 1–6 days). Vomiting stopped within 2–3 days of starting treatment in most patients. In 8 patients with a nasogastric tube, drainage decreased from 2000 to under 100 ml/day after the start of octreotide treatment. No side effects were reported. All patients died with minimal distress or pain.     

The Role of Bowel Surgery in the Primary Treatment of Epithelial Ovarian Cancer

Summary: Between January 1, 1979 and May 1, 1988, 24 of 192 patients treated for epithelial ovarian cancer underwent bowel surgery during primary therapy. It was found that survival was independent of this variable and depended largely upon the amount of residual disease following laparotomy. There was a major complication rate of 8% after primary bowel surgery, and this did not protect against the subsequent development of bowel obstruction. In conclusion, it is felt that bowel resection and anastomosis should only be undertaken if the patient is to be left with minimal or no macroscopic disease at completion of surgery.     

Chemotherapy and Total Parenteral Nutrition for Advanced Ovarian Cancer with Bowel Obstruction

We retrospectively reviewed the medical records of 21 patients with advanced epithelial ovarian carcinoma treated with intravenous chemotherapy in an attempt to restore intestinal function following small-bowel obstruction. All patients had a drainage gastrostomy tube placed for palliation of vomiting, and 11 patients received concomitant total parenteral nutrition (TPN). Eight (38%) patients were treated with single-agent paclitaxel, 7 (33%) received platinum-based regimens, and 6 (29%) received other second-line chemotherapy. The median survival for all patients post-gastrostomy tube placement was 84 days. The median survival for patients with recurrent ovarian cancer who received salvage chemotherapy and TPN was 89 days, longer than for patients who received salvage chemotherapy alone (71 days) (P= 0.031). Two of three patients with newly diagnosed ovarian cancer and concomitant bowel obstruction had sufficient temporary response from chemotherapy with resolution of obstruction and removal of the gastrostomy tube. Chemotherapy was ineffective in restoring bowel function in heavily pretreated patients with recurrent disease.     

Ⅳ期卵巢上皮性癌肿瘤细胞减灭术及预后因素的临床研究

目的 探讨Ⅳ期卵巢上皮性癌的肿瘤细胞减灭术的意义和预后因素。方法 回顾性分析我院１９８６年１月至１９９７年１２月,经手术病理分期的Ⅳ期卵巢上皮性癌７１例,其中切净组（残留灶≤１ｃｍ）３０例,未切净组（残留灶〉１ｃｍ）４１例。结果 手术切净率为４２．３％。Ⅳ期卵巢上皮性癌各转移部位中,锁骨上淋巴结转移和胸膜转移患者切净组的预后明显好于未切净组（Ｐ〈０．０５）。Ⅳ期卵巢上皮性癌的总５年生态２率为６．１     

Management of Advanced Ovarian Epithelial Cancer in the Renal Transplant Patient

Stage IIIC, grade I papillary serous adenocarcinoma of the ovary was diagnosed in a 28-year-old renal transplant recipient. She had been treated with the immunosuppressive agents azathioprine and methylprednisolone for 7 years prior to the discovery of the ovarian cancer. Surgical excision of the tumor was suboptimal due to involvement of the allograft; however, the patient achieved a complete clinical response after eight courses of cisplatin and cyclophosphamide. Since multiagent immunosuppressant therapy may have contributed to the development of the ovarian carcinoma, the intensity of immunosuppression was decreased by discontinuing the azathioprine as soon as the diagnosis of ovarian cancer was made. The methylprednisolone, however, was continued to decrease the possibility of organ rejection. After completion of chemotherapy, the patient was started on a daily regimen of low-dose oral cyclophosphamide as an immunosuppressant. Four months following the completion of cytotoxic therapy, she developed clinically evident disease in the pelvis. Subsequent salvage therapy with carboplatin failed. The patient died from progressive disease 26 months after initial diagnosis. She never developed evidence of renal rejection. Combined modality cancer therapy, preservation of allograft function, and modification of immunosuppressant therapy are important goals in the renal transplant patient with advanced ovarian carcinoma.     

Maximum Effort in the Management of Ovarian Cancer, Including Pelvic and Para-aortic Lymphadenectomy

Patients treated for ovarian cancer at the Mercy Hospital for Women, Melbourne over a 5 1/2 year period were studied with an emphasis on the need for lymphadenectomy. There were 80 patients identified with ovarian cancer. Forty patients underwent pelvic and/or para-aortic lymphadenectomy and 25 (62.5%) were found to have lymph node metastases, in 7 of the 40 women the lymphadenectomy resulting in upstaging of the disease. FIGO has adopted a surgicopathological approach to the staging of ovarian cancer and this requires lymphadenectomy to be performed. The importance of accurate staging in clinically early ovarian cancer and maximum surgical effort in advanced disease is discussed with particular regard to the place of lymphadenectomy.     

受侵肠段切除与联合化疗治疗卵巢癌肠转移62例分析

１９８３年３月至１９９６年２月间，在施行肿瘤细胞减灭术中，为６２在转移瘤侵犯深肌层或侵透肠腔的卵巢部做了胺侵肠段切除术。包括上皮性癌５５例，恶性生殖细胞瘤４例，性索间质瘤３例。其中Ⅱ期１例，Ⅲ期３９例，Ⅳ期２例，复发癌２０例。术式主要为小肠部分切除，结肠部分切险及乙状结肠直肠部分切除术。     

Long-Term Consequences Following Conservative Management of Epithelial Ovarian Cancer in an Infertile Patient

A 35-year-old woman with primary infertility underwent an ovarian cystectomy for a 5 x 4 cm left adnexal mass. There was no macroscopic evidence of metastatic disease. The final pathology report revealed a poorly differentiated serous cystadenocarcinoma. Because the patient desired to retain child-bearing capacity, she refused a surgical staging of her ovarian cancer. She elected to receive combination chemotherapy. This was then followed by a negative reassessment laparotomy. The patient was diagnosed with recurrent, metastatic ovarian carcinoma 10 years later.     

单克隆抗体治疗卵巢癌的研究进展

单克隆抗体治疗卵巢癌的实验与临床研究均已取得较大进展。贝伐单抗（nevacizumab,BEV）通过抑制新生血管形成,达到抑制肿瘤的目的;曲妥珠单抗（trastuzumab）、帕妥珠单抗（pertuzumab）选择性作用于人类表皮生长因子受体2,抑制肿瘤细胞的生长;西妥昔单抗（cetuximab）通过结合细胞表皮生长因子受体1,抑制细胞增殖、诱导凋亡;oregovomab通过与CA125形成免疫复合物,引起针对CA125的独特型免疫应答。单克隆抗体治疗卵巢癌可弥补传统治疗的不足。综述单克隆抗体治疗卵巢癌的研究进展。     

Second-Look Laparotomy in Ovarian Cancer

The role of the second-look laparotomy has become standard management in the patients with ovarian cancer without any objective evidence that it has a major impact on survival. In patients with early-stage disease, data on second-look surgery would suggest that there is very little, if any, benefit in patients who have had optimal full surgical staging and appropriate postoperative therapy. In advanced disease, even if the second-look laparotomy is negative, one-half will develop a recurrence. The role of the second-look laparotomy as a secondary debulking procedure has been suggested by some but appears to be beneficial in only a small subset of patients—less than 10%. In patients being treated on protocol, a second-look laparotomy has become the gold standard for determining effectiveness of a specific treatment being evaluated and would tend to be justified in this group to increase our knowledge and hopefully arrive at a better postsurgical therapy.     

单克隆抗体治疗卵巢癌的研究进展

单克隆抗体治疗卵巢癌的实验与临床研究均已取得较大进展。贝伐单抗（nevacizumab,BEV）通过抑制新生血管形成,达到抑制肿瘤的目的;曲妥珠单抗（trastuzumab）、帕妥珠单抗（pertuzumab）选择性作用于人类表皮生长因子受体2,抑制肿瘤细胞的生长;西妥昔单抗（cetuximab）通过结合细胞表皮生长因子受体1,抑制细胞增殖、诱导凋亡;oregovomab通过与CA125形成免疫复合物,引起针对CA125的独特型免疫应答。单克隆抗体治疗卵巢癌可弥补传统治疗的不足。综述单克隆抗体治疗卵巢癌的研究进展。     

Radiotherapy in Early Ovarian Cancer

Radiation therapy is an effective curative treatment modality in early ovarian cancer. A combination of the independent prognostic factors of grade, stage, and residual disease defines an "intermediate" risk group whose probability of long-term disease-free survival from abdomino-pelvic radiation therapy (APRT) is between 62 and 91%. This group in which abdomino-pelvic radiotherapy is recommended as the sole postoperative treatment is mainly constituted from patients with Stage II disease of all grades with no residuum or less than 2 cm residuum in the pelvis and selected optimal Stage III patients with low grade tumors. No therapy has been shown to benefit patients with Stage I grade 2 or 3 tumors, although relapse risks of 30% justify postoperative treatment in this group. APRT significantly reduced relapse risk in patients with Stages I and II disease, where tumors were densely adherent. The late toxicity of APRT is acceptable. When the abdominal dose is restricted to a total of 25 Gy and the pelvic dose to 45 Gy serious complications occur in less than 4% of patients. ³²P, widely utilized in early-stage disease, has not been shown to be beneficial compared to cisplatin in a study of the Norwegian Radium Hospital. Its dosimetry precludes effective dosing of tumor at a depth of more than 1 to 2 mm from the peritoneal surface and of the retroperitoneal nodes. Its use should be abandoned. APRT is an effective antitumor modality in ovarian cancer and cannot be discarded. Further studies of this modality are justified. Its future exploitation lies in manipulations to increase the therapeutic ratio by either altered radiotherapy fractionation schemes and/or potential combination with radiation sensitizers.     

卵巢癌中雷公藤内脂醇的研究进展

卵巢癌是严重威胁女性生殖健康的肿瘤之一,死亡率居各类妇科肿瘤的首位。多药耐药是治疗后复发、转移甚至死亡的主要原因。雷公藤内酯醇（triptolide,TP）具有很强的抗肿瘤活性,其在卵巢癌治疗方面的作用也引起了众多学者的重视,尤其是在多药耐药卵巢癌治疗中的应用。本文从抑制卵巢癌细胞增殖、诱导癌细胞凋亡两大方面综述雷公藤内酯醇在卵巢癌治疗中的研究进展。TP的毒性反应、半衰期短等缺点限制了其临床应用,纳米给药技术的出现为TP用于卵巢癌治疗提供了更广阔的应用前景。     

上皮性卵巢癌网膜切除术的研究进展

上皮性卵巢癌（EOC）是常见的妇科恶性肿瘤之一,早期不易发现,复发率和死亡率高。其治疗方法主要是以手术、化疗为主的综合治疗。因为该肿瘤经常会种植转移至网膜上,因此网膜切除术是标准分期手术和肿瘤减灭术中重要步骤之一。但是网膜切除术的范围却仍有争议。如果网膜有肉眼可见的肿瘤累及,则要切除全部受到肿瘤累及的网膜。而对于网膜无肉眼可见的肿瘤累及的患者,不同术者会选择不同范围的网膜切除术,其中最常见的是横结肠水平的网膜切除术。扩大切除范围可能会给患者带来更多获益的同时也会提高并发症的发生率。现就EOC治疗过程中的网膜切除术进行综述,以期为不同EOC患者提供更精确的治疗意见。     

子宫内膜异位症相关卵巢癌病因研究进展

子宫内膜异位症(endometriosis,EMs)在病理学表现上虽为良性病变,但具有与恶性肿瘤相似的浸润、种植生长、破坏周围组织、远处转移和极易复发的特点,并有一定比例的EMs会发生组织形态学改变,从非典型内膜异位组织进一步转变成癌。目前EMs恶变已受到世界各地学者的广泛关注。EMs和卵巢癌的组织联系虽早已被学者提出,并有公认的诊断标准,但是随着近年来EMs和卵巢癌发病率的增加,子宫内膜异位症相关卵巢癌(endometriosisassociated ovarian cancer,EAOC)愈发引起学者的重视,其病因、发病机制、流行病学特征等已成为近年的研究热点。就近年的研究成果主要从基因突变、细胞凋亡、炎症免疫、氧化应激、雌激素5个方面对EAOC的病因和发病机制进行阐述。