紫杉醇、顺铂联合化疗在晚期卵巢上皮性癌的应用

目的评价对晚期卵巢上皮性癌患者术后行紫杉醇静脉和顺铂腹腔灌注联合化疗的疗效及副反应。方法晚期卵巢上皮性癌30例行肿瘤细胞减灭术后,采用PT方案化疗,紫杉醇135mg/m2静脉滴注,顺铂60～80mg/m2腹腔灌注,21～28天1疗程,平均6～8个疗程数。结果Ⅲ期总有效率为76.92%,Ⅳ期为50.00%。结论PT方案联合化疗效果好,毒副反应轻,有助于提高患者5年生存率和生存质量。     

剂量密集化疗治疗晚期上皮性卵巢癌疗效观察

目的：探讨剂量密集化疗和标准化疗方案治疗晚期上皮性卵巢癌的临床疗效。方法：选取天津市第五中心医院院内化疗的晚期上皮性卵巢癌患者共89例,将患者随机分为剂量密集组45例和标准方案组44例,2组患者的年龄、病理分型和肿瘤临床分期差异均无统计学意义（P＞0.05）。标准方案组：紫杉醇180 mg/m2（静脉滴注维持3 h）,随后使用卡铂AUC 6（静脉滴注维持1 h,第1天）,间隔3周,共6个疗程。剂量密集组：紫杉醇80 mg/m2第1,8,15天+卡铂AUC 6（静脉滴注维持1 h,第1天）,每周期间隔3周,共6个疗程。2组进行治疗并随访3年,分别对2组患者的近期疗效、远期疗效和不良反应等进行比较。结果：剂量密集组总体缓解率高于标准方案组,差异有统计学意义（P＜0.05）;疾病无进展生存期（PFS）和3年生存率指标的比较,剂量密集组显著高于标准方案组（P＜0.01）;虽然其不良反应发生率亦高于标准方案组,但仅Ⅲ～Ⅳ级贫血发生率2组相比差异有统计学意义（P＜0.05）,其余发生率差异无统计学意义（P＞0.05）。结论：剂量密集化疗可有效提高晚期上皮性卵巢癌患者的3年生存率,延缓肿瘤复发。     

研究腹腔灌注结合静脉化疗方案治疗晚期卵巢癌的疗效

目的研究晚期卵巢癌患者采用腹腔灌注联合静脉化疗的疗效。方法随机选取我院晚期卵巢癌患者68例作为研究对象,随机分为对照组34例患者采用紫杉醇+顺铂联合静脉注射化疗与实验组34例患者则将顺铂采用腹腔灌注与紫杉醇静脉化疗结合作为治疗方案。疗程6个月,对比两组患者的相关指标。结果实验组患者的疗效比对照组显著,不良反应发生率比对照组低,差异有统计学意义(P0.05)。结论采用腹腔灌注与静脉化疗结合的方式对晚期卵巢癌的患者进行化疗能够提高疗效,减轻患者痛苦。     

高精度持续循环腹腔热灌注化疗联合静脉化疗治疗卵巢癌的临床研究

目的：观察高精度持续循环腹腔热灌注化疗（IPHC）联合静脉化疗治疗卵巢癌的临床疗效。方法：分析2011—2012年就诊于郑州大学人民医院50例行满意的卵巢癌减灭术患者,随机分为2组。灌注组28例,行高精度持续循环IPHC联合静脉化疗;对照组22例,行“紫杉醇脂质体135 mg/m2+奥沙利铂135 mg/m2”方案（PT方案）静脉化疗,观察2组患者的临床治疗效果。结果：2组患者术后1个月、3个月血清CA125降至正常比例比较差异有统计学意义（均P＜0.05）。2组患者术后1个月、3个月腹水治疗有效率比较差异有统计学意义（均P＜0.05）。需要对症处理的化疗后Ⅱ级毒副反应灌注组低于对照组（χ2=7.417,P=0.006）。生活质量改善率灌注组高于对照组（χ2=5.936,P=0.015）。结论：高精度持续循环IPHC联合静脉化疗能够提高卵巢癌的临床疗效,有效地控制卵巢癌恶性腹水,降低严重的化疗毒副反应的发生率,改善生活质量。     

腹腔热灌注联合多西他赛、奥沙利铂静脉化疗治疗晚期卵巢癌疗效观察

目的:探讨肿瘤细胞减灭术(CRS)后腹腔热灌注联合多西他赛、奥沙利铂静脉化疗治疗晚期卵巢癌的临床疗效。方法:取2011年1月至2014年12月在河北医科大学第二医院就诊的晚期卵巢癌患者42例,其中观察组21例(CRS后+腹腔热灌注+多西他赛、奥沙利铂静脉化疗)、紫杉醇+卡铂组21例(CRS后+紫杉醇、卡铂静脉化疗)。比较两组的疗效、肿瘤控制、腹水控制、生活质量、治疗过程中的不良反应及并发症、无进展生存期(PFS)等。结果:观察组与对照组肿瘤控制差异无统计学意义(P0.05);腹水控制、生活质量、PFS均优于对照组,差异有统计学意义(P0.05)。不良反应及并发症无明显差异(P0.05)。结论:在临床上对于晚期卵巢癌患者采取CRS术后腹腔热灌注联合多西他赛、奥沙利铂静脉化疗,对于患者的疗效、肿瘤控制、腹水控制、生活质量、PFS有提高,且不明显增加不良反应及并发症。     

紫杉醇联合奥沙利铂治疗复发性或晚期宫颈癌临床疗效分析

目的：探讨分析紫杉醇联合奥沙利铂治疗复发性或晚期宫颈癌的临床疗效及不良反应。方法：选取北京同仁医院32例复发性或晚期宫颈癌,给予紫杉醇联合奥沙利铂化疗方案：第1天紫杉醇150 mg/m2静脉滴注≥3 h,第2天奥沙利铂130 mg/m2静脉滴注≥2 h,每21天为1个周期,治疗2个周期后进行评价,评估患者近远期疗效及不良反应。结果：全部患者均可参与评价疗效,总有效率为25.0%,中位无进展生存期（progression-free survival,PFS）和中位总生存期（overall survival,OS）分别为21.2周和52.1周。主要不良反应为神经毒性和骨髓抑制,非血液学不良反应较轻。结论：紫杉醇联合奥沙利铂治疗复发性或晚期宫颈癌患者疗效肯定,不良反应可以耐受,值得进一步临床研究。     

晚期卵巢癌化学治疗的新进展

多数卵巢癌患者就诊时即为晚期,故死亡率较高.化疗是晚期卵巢癌的主要治疗方法之一.紫杉醇/顺铂或卡铂静脉化疗已成为晚期卵巢癌一线治疗方案,使其疗效及预后有一定程度改善.腹腔化疗、淋巴管灌注化疗、动脉化疗及高剂量化疗等的临床研究进展,为晚期卵巢癌治疗提供多种途径.     

晚期卵巢癌化学治疗的新进展

多数卵巢癌患者就诊时即为晚期，故死亡率较高。化疗是晚期卵巢癌的主要治疗方法之一。紫杉醇／顺铂或卡铂静脉化疗已成为晚期卵巢癌一线治疗方案，使其疗效及预后有一定程度改善。腹腔化疗、淋巴管灌注化疗、动脉化疗及高剂量化疗等的临床研究进展，为晚期卵巢癌治疗提供多种途径。     

卵巢癌腹腔化疗的有关问题

晚期卵巢癌标准一线治疗方案为肿瘤细胞减灭术+铂类为基础的联合化疗.作为卵巢癌最重要的辅助治疗,卵巢癌标准一线化疗经历了顺铂+阿霉素+环磷酰胺(PAC)和顺铂+环磷酰胺(PC)、顺铂+紫杉醇(PT)和当前标准化疗方案卡铂+紫杉醇(CT)几个阶段,标准给药方式均为静脉化疗,取得了良好的临床疗效,患者生存率逐步改善.然而,卵巢癌多局限于盆、腹腔内种植生长,因此,腹腔内局部给药即腹腔化疗(intraperitoneal chemotherapy)具有重要的理论依据.     

顺铂腹腔化疗与静脉化疗对理想减瘤术后晚期卵巢癌的疗效比较

为确定顺铂腹腔化疗与静脉化疗在减瘤术后的晚期卵巢癌的疗效,进行比较研究。本组113例1989年始～1996年止,经FIGO分期为Ⅱ～Ⅲ期卵巢癌病例,细胞减灭术后残余肿瘤均<2cm,术后随机分成两组,接受顺铂、表阿霉素及环磷酰胺(PEC)化疗:组1为腹腔化疗组,即顺铂50mg/m~2腹腔化疗联合表阿霉素60mg/m~2和环磷酰胺600mg/m~2     

Intraperitoneal hyperthermic chemotherapy in ovarian cancer

We investigated the effect of intraperitoneal hyperthermic perfusion chemotherapy as consolidation therapy in stage IIIB-IIIC ovarian cancer, following cytoreductive surgery and systemic chemotherapy (cisplatin-cyclophosphamide--six cycles). Disease-free survival, overall survival, and side effects were compared with a control group of patients who refused a second-look surgery and intraperitoneal chemotherapy. In a multicenter prospective trial, 29 patients with complete or optimal cytoreductive surgery and systemic treatment were included in the consolidation group and received intraperitoneal hyperthermic perfusion chemotherapy. Patients were recruited between January 1991 and December 1997. The intraperitoneal hyperthermic perfusion was performed with open-abdomen technique, using physiologic solution containing cisplatin 100 mg/m2, for 60 min in hyperthermic phase (41-43 degrees C). Intraperitoneal hyperthermic perfusion chemotherapy was locally and systemically well tolerated. The consolidation therapy group showed a better 5-year survival rate and lower recurrent disease rate, but differences were not statistically significant. Our results suggest that intraperitoneal hyperthermic perfusion chemotherapy is a feasible, well-tolerated, and promising alternative as consolidation therapy in ovarian cancer.     

肿瘤细胞减灭术后行腹腔热灌注5-FU+卡铂化疗联合静脉化疗治疗晚期卵巢癌的效果观察#br#

目的探讨吉西他滨新辅助化疗(NACT)对比同步放化疗(CCRT)对年轻宫颈癌患者临床预后及细胞增殖-凋亡相关因子表达的影响。方法纳入局部晚期宫颈癌患者140例,随机分为观察组与对照组各70例。对照组采用吉西他滨和顺铂方案NACT,观察组采用以吉西他滨为基础CCRT。对比两组手术情况、副作用及生存情况,治疗前后血管内皮生长因子(VEGF)、Caspase-3、Survivin、Bax、Bcl-2表达。结果两组手术时间比较,差异无统计学意义(P0.05);观察组的手术时间及切缘阳性率均低于对照组(P 0.05)。观察组3年生存率显著高于对照组(P 0.05),观察组的复发、转移率显著低于对照组(P 0.05)。观察组放射性肠炎及放射性膀胱炎显著高于对照组(P 0.05)。治疗后,观察组的VEGF、Survivin、Bal-2阳性表达率、未复发转移低于对照组,Caspase-3、Bax阳性表达率、未复发转移患者高于对照组(P 0.05)。结论吉西他滨NACT与CCRT治疗年轻宫颈癌的近期疗效相当,但CCRT可能改善远期生存获益,其机制可能与抑制细胞增殖因子及上调细胞凋亡因子有关。     

Intraperitoneal versus intravenous cisplatin in combination with intravenous cyclophosphamide and epidoxorubicin in optimally cytoreduced advanced epithelial ovarian cancer: a randomized trial of the Gruppo Oncologico Nord-Ovest

Intraperitoneal chemotherapy has a strong biological and pharmacological rationale in the treatment of ovarian cancer. From 1989 to 1996 the present study included 113 patients with FIGO stage II-IV ovarian cancer with residual disease less than 2 cm who were randomly allocated to receive 50 mg/m(2) intraperitoneal cisplatin (CDDP) plus 60 mg/m(2) intravenous epidoxorubicin (EPIDOX) and 600 mg/m(2) intravenous cyclophosphamide (CTX) (ipPEC arm) or 50 mg/m(2) intravenous CDDP plus 60 mg/m(2) intravenous EPIDOX and 600 mg/m(2) intravenous CTX (ivPEC arm). Chemotherapy was repeated every 4 weeks for six cycles. Treatment protocol was changed in 22 patients, 2 from the iv arm (who received single-agent carboplatin) and 20 from the ip arm (who were crossed to systemic chemotherapy, ivPEC, or single-agent carboplatin). At the end of chemotherapy, a second-look was performed in 33 of the 54 patients from the ip arm and in 34 of the 57 patients from the systemic arm. The pathologic complete response rate was 41% of all entered patients and 69% of patients submitted to second-look. No significant difference in pathologic response rate as well as in hematologic and nonhematologic toxicities was seen between the two arms. Up to September 1998, 72 patients showed a disease recurrence (33 treated with ipPEC and 39 treated with ivPEC), 55 died (22 ipPEC and 30 ivPEC), and 10 were lost to follow-up (6 ipPEC and 4 ivPEC). Median progression-free survival was 42 and 25 months for ipPEC and ivPEC, respectively (p = 0.13). Median overall survival was 67 and 51 months for ipPEC and ivPEC, respectively (p = 0.14). In conclusion, besides confirming that intraperitoneal chemotherapy is feasible with acceptable toxicity but with poor compliance in community hospitals, this trial showed that intraperitoneal CDDP compared with intravenous CDDP in combination with EPIDOX and CTX obtained a slight (not significant) improvement in progression-free survival and overall survival of optimally cytoreduced advanced ovarian cancer patients.     

Phase I feasibility study of intraperitoneal cisplatin and intravenous paclitaxel followed by intraperitoneal paclitaxel in untreated ovarian, fallopian tube, and primary peritoneal carcinoma: a gynecologic oncology group study

Purpose

Intraperitoneal chemotherapy has shown a survival advantage over intravenous chemotherapy for women with newly diagnosed optimally debulked epithelial ovarian, fallopian tube, or primary peritoneal carcinoma. However, significant toxicity has limited its acceptance. In an effort to reduce toxicity, the Gynecologic Oncology Group conducted a Phase I study to evaluate the feasibility of day 1 intravenous (IV) paclitaxel and intraperitoneal (IP) cisplatin followed by day 8 IP paclitaxel on an every 21-day cycle.

Methods

Patients with Stage IIB-IV epithelial ovarian, fallopian tube, primary peritoneal carcinomas or carcinosarcoma received paclitaxel 135 mg/m² IV over 3 h followed by cisplatin 75 mg/m² IP on day 1 and paclitaxel 60 mg/m² IP on day 8 of a 21 day cycle with 6 cycles planned. Dose-limiting toxicity (DLT) was defined as febrile neutropenia or dose-delay of greater than 2 weeks due to failure to recover counts, or Grade 3–5 non-hematologic toxicity occurring within the first 4 cycles of treatment.

Results

Twenty of 23 patients enrolled were evaluable and nineteen (95%) completed all six cycles of therapy. Three patients experienced a DLT consisting of infection with normal absolute neutrophil count, grade 3 hyperglycemia, and grade 4 abdominal pain.

Conclusions

This modified IP regimen which administers both IV paclitaxel and IP cisplatin on day one, followed by IP paclitaxel on day eight, of a twenty-one day cycle appears feasible and is an attractive alternative to the intraperitoneal treatment regimen administered in GOG-0172.     

Secondary debulking surgery and intraperitoneal chemotherapy in advanced or recurrent epithelial ovarian cancer

OBJECTIVE: The aim of this study was to evaluate the indications and the results of secondary cytoreduction surgery with intraperitoneal (i.p.) paclitaxel chemotherapy in advanced or recurrent epithelial ovarian cancer. PATIENTS AND METHODS: In a retrospective study, records were reviewed for 13 patients who received i.p. paclitaxel therapy (175 mg/m2) during secondary cytoreductive surgery or surgery for recurrent disease. All these patients were initially treated with optimal debulking surgery (macroscopic persistent residual disease) and systemic chemotherapy. RESULTS: Nine patients were operated for secondary cytoreductive surgery (group I) and four patients operated for recurrent disease (group II). Postoperative residual disease was absent or microscopic in 69% (n = 9). Median hospital stay was 16 days. Hematologic toxicity grade III-IV was reported by 12 patients (92%). Operative mortality was 7.7% (n = 1). Median follow-up was 22.7 months. The median overall survival was 25.5 months. The median disease-free survival was 8.5 months. The median disease-free survival for group I and II were respectively 11.7 months and 4.2 months (P = 0.3). Progression of disease after completion of treatment was documented in 62% (n = 8): six patients for group I and two patients for group II. DISCUSSION AND CONCLUSION: Secondary cytoreduction surgery associated with intraperitoneal chemotherapy is feasible after adjuvant systemic chemotherapy for patients with recurrent or suboptimally resected ovarian cancer. Results on loco-regional control for recurrent disease are poor. Intraperitoneal chemotherapy should be discussed during a two-step surgical strategy, as secondary cytoreductive surgery.     

Comparison of quality of life in patients with advanced ovarian cancer treated with intraperitoneal or intravenous cisplatin and cyclophosphamide as a second line of therapy

OBJECTIVES: The study aimed to compare the effect of second line intravenous and intraperitoneal chemotherapy on physical and psychological aspects of quality of life in patients with advanced ovarian cancer. MATERIALS AND METHODS: Quality of life was measured with EORTC QLQ-C30 (version 3.0) questionnaire. 42 sample patients with histologically confirmed diagnosis of advanced epithelial ovarian cancer treated with second line intravenous or intraperitoneal chemotherapy were included in the study. RESULTS: Higher score of global quality of life and less side-effects of chemotherapy were observed in the group of patients treated with intraperitoneal chemotherapy. In this group constipation and dyspnoea were less common. CONCLUSION: Intraperitoneal chemotherapy has less negative influence on quality of life than intravenous drug delivery.     

Systematic review of first-line chemotherapy for newly diagnosed postoperative patients with stage II, III, or IV epithelial ovarian cancer

OBJECTIVE: The aim of this study was to determine the optimal postoperative chemotherapy regimen for women with newly diagnosed stage II, III (micro or macro), or IV epithelial ovarian cancer. METHODS: A systematic search was conducted to find randomized controlled trials and meta-analyses published between 1980 and April 2001. RESULTS: A published meta-analysis found that, compared with non-platinum-based regimens, platinum, alone or in combination with other agents, improved survival when used as first-line chemotherapy for ovarian cancer. The meta-analysis did not detect a difference in efficacy between cisplatin and carboplatin. A published randomized trial of cisplatin plus paclitaxel versus carboplatin plus paclitaxel did not detect a significant difference in survival between these regimens. In two randomized trials, treatment with paclitaxel plus cisplatin resulted in improved survival compared with cyclophosphamide plus cisplatin. A randomized trial of paclitaxel plus cisplatin versus paclitaxel alone versus cisplatin alone detected no differences in survival among the three treatment groups. While hematologic adverse effects were more frequent with carboplatin than with cisplatin, nonhematologic adverse effects were less frequent with carboplatin. The addition of paclitaxel to cisplatin did not appear to increase the incidence of serious adverse effects. CONCLUSIONS: Intravenous carboplatin plus paclitaxel is the recommended postoperative chemotherapy regimen for newly diagnosed stage II-IV epithelial ovarian cancer. Intravenous cisplatin plus paclitaxel may also be considered a treatment option. Intravenous carboplatin as a single agent may be considered a treatment option in patients for whom paclitaxel is contraindicated or in patients who are unwilling to accept the adverse effects of paclitaxel chemotherapy.