非生殖道来源的转移性卵巢癌的治疗及预后

目的探讨非生殖道来源的转移性卵巢癌的治疗方法与预后因素。方法回顾性分析武汉大学中南医院妇瘤科从1998年1月至2004年2月收治的34例非生殖道来源的转移性卵巢癌患者的临床病理资料。根据治疗方法的不同分为4组,A组(7例):行满意的肿瘤细胞减灭术;B组(9例):行满意的肿瘤细胞减灭术+术后系统化疗;C组(14例):行不满意的肿瘤细胞减灭术;D组(4例):行不满意的肿瘤细胞减灭术+术后系统化疗。对各组患者的生存时间及预后影响因素进行比较分析。结果非生殖道来源的转移性卵巢癌占同期收治的卵巢癌患者的8.8%。34例患者中,31例(91%)来源于胃肠道,2例(6%)来源于乳腺,1例(3%)来源不明。A、B、C、D组患者的中位数生存时间分别为5.0、10.0、4.0、6.5个月,除A组与B组、B组与C组、C组与D组间比较,差异有统计学意义(P<0.05)外,其余各组间比较,差异均无统计学意义(P>0.05)。单因素和多因素分析均显示,术后残留灶直径及术后系统化疗是影响预后的因素。结论非生殖道来源的转移性卵巢癌主要来源于胃肠道肿瘤,此类患者应予满意的肿瘤细胞减灭术,术后再辅以系统化疗,能显著改善患者的预后。     

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     

主动循环热灌注化疗对卵巢癌腹水疗效及HE4、CA125、VEGF和B7-H4水平的影响

目的 探讨卵巢癌腹水患者采用主动循环腹腔热灌注化疗治疗的效果及对血清肿瘤相关标记物水平的影响.方法 选取84例卵巢癌伴腹水患者,根据腹腔热灌注化疗方法分为主动循环组和常规组各42例,两组患者采用紫杉醇+顺铂实施不同的腹腔热灌注治疗.结果 主动循环组与常规组进入腹腔时的灌注液体温度差异无统计学意义(P>0.05),抽出腹...     

观察卵巢癌患者术后腹腔化疗的护理效果

目的观察卵巢癌患者术后腹腔化疗的护理措施和效果。方法选取2012年2月~2014年2月我院收治的卵巢癌术后进行腹腔化疗的患者31例作为研究对象,所有患者均采取优质的腹腔化疗护理方式,包括化疗的相关护理、心理护理、出院指导等。随访半年,观察所有患者的临床症状和生活质量改善情况。结果半年后复查发现,患者中显效13例,有效14例,无效4例,总有效率为87.1%。结论对卵巢癌术后腹腔化疗的患者进行专业的护理可以有效改善患者临床症状、缓解患者疼痛、改善生活质量,对于临床治疗和患者恢复健康有着重要的意义。     

复发性卵巢癌腹腔化疗

卵巢癌是妇科肿瘤中死亡率居首位的肿瘤,尽管初始的铂类联合紫杉醇的一线化疗对75%左右的患者有效,但80%以上患者最终死于肿瘤复发。虽然腹腔化疗联合静脉化疗作为一线化疗方法较单纯静脉化疗可显著延长晚期卵巢癌患者的生存期,但腹腔化疗在复发性卵巢癌的疗效尚不明确。     

动静脉留置套管针进行腹腔穿刺化疗19例体会

腹腔化疗是卵巢癌治疗的重要途径 ,我科自 1998年 13月为 19例卵巢癌术后患者应用动静脉留置套管针穿刺给药进行腹腔化疗 ,共 34例次 ,取得较好效果 ,现报道如下。1　资料与方法1 1　研究对象　为 1998年 13月在我科进行术后常规化疗的卵巢癌患者 19例 ,年龄 376 7岁 ,平均年龄 5 1 2 5岁。以上患者均在我科进行了肿瘤细胞减灭术 ,术后病理确诊(卵巢癌临床分期 ) :Ⅰ期 1例 (5 2 6 % ) ,Ⅱ期 10例(5 2 6 3 % ) ,Ⅲ期 8例 (4 2 11% )。患者均无明显盆腹腔粘连症状。1 2　方法　采用德国生产的ＶａｓｏｃａｎＢｒａｕｎｕｌｅＩｎｔｒｏｃ…     

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。     

卡铂腹腔化疗在晚期卵巢癌患者中的应用研究

目的探讨并分析卡铂腹腔化疗在晚期卵巢癌患者中的应用价值。方法对2007年9月至2017年9月郑州大学第一附属医院收治的Ⅱ～Ⅳ期卵巢癌患者183例进行前瞻性分析,利用随机数字表将患者分为三组:紫杉醇联合卡铂静脉化疗组(A组)67例、紫杉醇联合卡铂腹腔化疗组(B组)52例与紫杉醇联合顺铂腹腔化疗组(C组)64例,通过比较三组间化疗有效率、生存情况与毒副反应,评估卡铂腹腔化疗的有效性与安全性。结果 A、B、C组的有效率分别为85.07%、88.46%与90.63%,组间差异均无统计学意义(P0.05)。无进展生存时间(PFS)分别为:A组(22.04±2.07)个月,B组(27.79±1.93)个月,C组(26.43±2.49)个月;但组间差异均无统计学意义(P0.05)。A组总生存时间(OS)为(48.02±3.54)个月;B组(49.78±2.88)个月;C组(48.94±2.12)个月,三组间差异无统计学意义(P0.05)。三组间Ⅲ～Ⅳ级骨髓抑制的发生率无明显差异(P0.05)。Ⅲ～Ⅳ级腹痛及胃肠道反应发生情况:C组分别与A组、B组比较,差异均有统计学意义(P0.05),A组与B组间差异无统计学意义(P0.05)。结论卡铂腹腔化疗的临床有效性与卡铂静脉化疗及顺铂腹腔化疗相近,但化疗毒副作用发生率相对较低,具有一定临床价值。     

卵巢癌术后腹腔化疗对切口愈合的影响

卵巢癌术后腹腔化疗对切口愈合的影响陈亚侠谢幸石一复为了探讨术后开始腹腔化疗时间与发生切口并发症的关系，从而提出卵巢癌患者术后理想的开始化疗时间。我们对在我院初次手术后施以铂类药物为主腹腔化疗的８８例卵巢癌患者，回顾性分析其化疗及切口愈合情况。现报告如...     

腹腔注射碳铂治疗最小残留卵巢癌

以顺铂为主的联合化疗治疗晚期卵巢癌,完全病理有效率大约为25%。二次探查术后残留病灶<1～2 cm,称为最小残留病灶,占卵巢癌患者的15～20%。在顺铂以后的第二线药物静脉化疗很难奏效。由于残留卵巢癌长期局限于腹腔内,腹腔内注射药物可使隐匿的病灶处于高浓度的药物之中。因此,在最小残留灶患者可获得30%的完全有效率。持续性的神经毒性和肾毒性是长期使用顺铂的主要限制性因素。碳铂(Carboplatin)系第二代铂衍生物,神经毒性和肾毒性小。本文报告1985年4月至1988年10月经腹腔注射碳铂治疗31例最小残留卵巢癌的治疗结果。 31例均经病理组织学诊断为卵巢癌。平均年龄56岁,按FIGO分期:Ⅰ～Ⅱ期2例,Ⅲ期28例,     

Phase 2 trial of intraperitoneal carboplatin and etoposide as salvage treatment of advanced epithelial ovarian cancer

To evaluate the efficacy of intraperitoneal (IP) carboplatin-based therapy as salvage treatment of ovarian cancer, 46 patients with persistent or recurrent ovarian cancer following initial systemic chemotherapy were treated with a regimen of carboplatin (200-300 mg/m2) and etoposide (100 mg/m2) administered on a monthly schedule. A maximum of six courses of therapy was delivered, followed by a response laparotomy. The treatment program was well tolerated, except for bone marrow suppression, with one-quarter of patients developing platelet count depressions to < or = 50,000/mm3, and one-third experiencing hemoglobin levels of < or = 8 g/dl during treatment. Twelve (38%) of 32 patients evaluable for efficacy of the treatment program achieved a surgically documented response, including 8 (25%) complete responses. Of 25 patients whose largest tumor mass at the initiation of therapy measured < or = 0.5 cm, 11 (44%) responded, including 8 (32%) complete responses. We conclude that the IP administration of carboplatin can result in surgically documented responses when used in the salvage setting in patients with advanced ovarian cancer. The relative efficacy of carboplatin versus cisplatin when administered by the IP route to patients with ovarian cancer previously treated with platinum-based systemic therapy remains to be defined.     

Intraperitoneal chemotherapy for patients with advanced ovarian cancer: a review of the evidence and standards for the delivery of care

OBJECTIVES: To evaluate the role of intraperitoneal (IP) chemotherapy as part of primary treatment in patients with advanced ovarian cancer and to develop standards of care within the context of current clinical practice. METHODS: A multidisciplinary expert panel, convened to develop standards on the use of IP chemotherapy, searched the MEDLINE, EMBASE, and Cochrane Library databases up to December 2006 for randomized trials or published standards on the efficacy and/or delivery of IP chemotherapy. RESULTS: Eight randomized trials comparing IP chemotherapy versus intravenous (IV) chemotherapy were identified. Three trials reported statistically significant improvements in median survival of 8.0, 11.0, and 15.9 months with cisplatin-based IP chemotherapy. In one trial, the 15.9-month improvement in median overall survival (RR=0.75, 95% CI=0.58-0.97) represented a 25% reduction in the risk of death with IP chemotherapy. Severe adverse events and catheter-related complications were often dose limiting with IP chemotherapy. Using a consensus-based approach with a nationally representative panel, multidisciplinary care standards were developed to review medical and surgical criteria, the practice setting, volume requirements, and the institutional criteria required to safely deliver IP chemotherapy. CONCLUSION: The survival benefits with cisplatin-based IP chemotherapy may represent a significant improvement in the outlook for select patients with advanced ovarian cancer. The delivery of IP chemotherapy is more challenging than the IV route; however, severe adverse events and catheter-related complications may be offset through research defining the optimum treatment regimen, and the standardization of care. System-wide standards for the delivery of IP chemotherapy in Canada for patients with optimally debulked stage III ovarian cancer are offered.     

A meta-analysis of the efficacy of intraperitoneal cisplatin for the front-line treatment of ovarian cancer

Ovarian cancer is the fourth leading cause of cancer death among women in the United States. First-line chemotherapy offered to patients with ovarian cancer generally consists of an intravenous (IV) platinum plus taxane regimen and has remained virtually unchanged for the past 10 years. A number of recently completed phase III randomized trials in the United States have reported improved progression-free survival (PFS) and/or overall survival (OS) with the intraperitoneal (IP) administration of cisplatin. The purpose of this study was to pool the published data to perform a meta-analysis of randomized trials of IP cisplatin in the initial chemotherapy treatment of ovarian cancer patients. This study was initiated to obtain a more valid estimate of the therapeutic impact of IP treatment for these patients. A search strategy was initiated that searched published findings of randomized trials of IP cisplatin therapy from multiple sources from January 1990 through January 2006. Six randomized trials of 1716 ovarian cancer patients were identified and included in this analysis. The pooled hazard ratio (HR) for PFS of IP cisplatin as compared to IV treatment regimens is 0.792 (95% CI: 0.688-0.912, P= 0.001), and the pooled HR for OS is 0.799 (95% CI: 0.702-0.910, P= 0.0007). These findings strongly support the incorporation of an IP cisplatin regimen to improve survival in the front-line treatment of stage III, optimally debulked ovarian cancer.     

Intraperitoneal chemotherapy for advanced epithelial ovarian cancer: a Canadian perspective

The objectives of this study were to: a) assess the position of Canadian gynecological oncologists (GOC) toward intraperitoneal (IP) chemotherapy as primary treatment for ovarian cancer, b) initiate a process of communication among GOC, and c) assess the perception of barriers to implementing IP chemotherapy across Canada. An electronic practice survey was mailed to all GOC in January 2006. The response rate was 62%. GOC accept IP chemotherapy as the standard of care in the primary treatment of optimally debulked epithelial ovarian cancer. The majority of respondents were working on implementation strategies at their local institutions. The cost of administration and use of additional resources were identified as sources of moderate and high concerns, respectively. Moderate concerns were expressed with regard to the management of systemic and local toxicity, catheter complications, patients' acceptance, and quality of life. Catheter insertion issues were of low concern to most respondents. Previous experience with IP administration did not significantly impact the perceived level of concern. GOC support the use of IP chemotherapy for appropriate patients with ovarian cancer. This survey identifies important implementation challenges of IP therapy for Canada, and processes must be developed before successful delivery of IP chemotherapy can be realized. This survey serves to initiate a process of communication among GOC. A collaborative effort will be needed to facilitate this change in practice. Further study of the implementation process is warranted as more experience is gained with this modality of treatment.     

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。     

卵巢癌腹腔化疗应用现状与相关问题

腹腔化疗作为卵巢癌的一种区域性治疗方式,被应用于卵巢癌的化疗治疗中,包括微小残留病灶的一线化疗,标准治疗后病理完全缓解的巩固治疗,以及复发性卵巢癌的二线化疗。文章介绍了关于卵巢癌腹腔化疗的临床应用及现存问题。     

TP、PTP及CAP化疗方案治疗上皮性卵巢癌的比较

目的探讨进口紫杉醇(泰素)与铂类联合化疗方案(TP)、国产紫杉醇(紫素)与铂类联合化疗方案(PIP)治疗上皮性卵巢癌的疗效及毒性,并与环磷酰氨、阿霉素及铂类方案(CAP)进行比较。方法对1993年12月至1999年4月采用TP、PIP及CAP化疗方案治疗的卵巢癌患者进行回顾性分析。泰素组(TP组)22例、紫素组(PTP组)18例,CAP组38例。结果泰素组有效率为55.6％,紫素组有效率为71.4％;紫杉醇作为一线用药有效率为88.9％,CAP作为一线用药有效率为55.9％。紫杉醇的毒副作用有造血功能抑制、消化道症状、脱发、外周神经炎、肌肉、关节疼痛,其中2例出现Ⅲ度外周神经损伤。结论TP或PTP作为一线用药疗效高于CAP,国产及进口紫杉醇在疗效及副作用上无明显差异。     

Interferon-gamma in combination with carboplatin and paclitaxel as a safe and effective first-line treatment option for advanced ovarian cancer: results of a phase I/II study

We have previously shown that interferon-gamma 1b (IFN-gamma) in combination with cyclophosphamide and cisplatin significantly prolongs progression-free survival in ovarian cancer. In this phase I/II study, we examined if administration of IFN-gamma is also safe in combination with the current standard treatment, paclitaxel and carboplatin. Thirty-four patients with newly diagnosed advanced epithelial ovarian cancer, FIGO stage III/IV, were treated for six to nine cycles with paclitaxel (175 mg/m(2)) and carboplatin (area under the curve [AUC] 5) every 3 weeks. IFN-gamma was administered in an escalating dose from 6 days/cycle with 0.025 mg sc up to 9 days/cycle with 0.1 mg sc. As expected, administration of IFN-gamma was associated with flu-like symptoms. Grade 3/4 neutropenia was observed in 74% (25 out of 34) of patients. Other side effects, in particular peripheral neuropathies, were within the previously observed ranges for the paclitaxel plus carboplatin combination. Overall response rate (complete or partial response) in patients who received either six or nine doses (0.1 mg) of IFN-gamma/cycle (n = 28) was 71%. IFN-gamma is safe in combination with carboplatin and paclitaxel for first-line treatment of patients with advanced ovarian cancer. This combination should be further evaluated as an immunotherapeutic treatment option for ovarian cancer.     

Intraperitoneal interferon-alpha in residual ovarian carcinoma: a phase II gynecologic oncology group study.

OBJECTIVE: The purpose of this study was to confirm the activity of interferon-alpha intraperitoneally in minimal residual epithelial ovarian cancer in a Phase II multi-institutional trial and to investigate the activity of the agent based on prior response to first-line platinum compounds. METHODS: Ninety-two patients with minimal residual (<0.5 cm) epithelial ovarian cancer at reassessment laparotomy were entered into a multicenter trial of intraperitoneal interferon-alpha given for 12 cycles unless disease progression or unacceptable toxicity occurred first. Patients were considered favorable if they were platinum sensitive and/or relapsed 6 months or longer after completing treatment and unfavorable if they were platinum insensitive and/or relapsed shorter than 6 months after completing treatment and/or had stable or progressive disease during initial therapy. A third-look laparotomy was performed within 12 weeks of completion of treatment in those patients who were in clinical remission. RESULTS: Eighty patients were clinically evaluable for toxicity only (48 favorable, 32 unfavorable) and 46 of them were evaluable for response, of whom 25 were favorable (platinum sensitive) and 21 unfavorable (platinum resistant). In the favorable group, there was a 28% surgically documented response rate (7/25 patients): 16% (4/25) had complete responses (negative reassessment operation), 12% (3/25) had partial responses, 32% (8/25) were nonresponders, and 40% (10 patients) developed progressive disease before planned reassessment operation. In the unfavorable group, there were no responding patients: 6 were nonresponders at reassessment operation and 15 developed progressive disease before planned reassessment operation. Of the 80 patients evaluable for toxicity, the most common adverse effects that were more than grade 2 were gastrointestinal (12; 15%), fever (8; 10%), neutropenia (7;9%), and leukopenia (6; 8%). Grade 4 toxicity was seen in 5 patients; each had fever and gastrointestinal toxicity, and 1 each had neutropenia and thrombocytopenia. CONCLUSIONS: Interferon-alpha is an active and generally well-tolerated agent in favorable patients with minimal residual epithelial ovarian cancer at second-look surgery. These results are comparable to those achieved with cytotoxic chemotherapy. If Phase III trials are considered in the patients with minimal residual ovarian cancer, they should be limited to the platinum-sensitive patient population.     

Five-year survival rate of postoperative ovarian cancer patients:a 15-year retrospective study

Objective:Ovarian cancer has the highest mortality rate of all gynecologic tumors. We compared the survival rate of ovarian cancer patients with different histological types and different time periods,aiming to elucidate the therapeutic effect and provide more evidence for the prevention and treatment of ovarian cancer.Methods:605 patients with ovarian cancer who underwent surgery at Qilu Hospital,Shandong University from September 1998 to August2012 were retrospectively reviewed. The 5-year survival rate was calculated in epithelial ovarian cancer(EOC)and non-epithelial ovarian cancer(Non-EOC). In addition,the patients were divided into two groups according to time at diagnosis(September 1998 to August 2007 and September 2007 to August 2012). The difference of 5-year survival rate between these two periods was compared.Results:The 5-year overall survival rate of all patients with ovarian cancer was59. 2% from September 1998 to August 2012. The survival rate of patients with EOC was lower(63. 0%)than that of Non-EOC(90. 8%). For both histological types,the 5-year survival rate of patients with localized disease(90. 8%)was significantly higher than that of patients with distant-stage(57. 6%). For different time periods,there was no significant difference in 5-year survival rate between ovarian cancer with different stages.Conclusion:Histological types and stages are closely related to survival of patients with ovarian cancer. More comprehensive clinical and follow-up information could provide convincing evidence for the prevention and treatment of ovarian cancer.