Salvage therapy for recurrent epithelial ovarian cancer

There are no comparative prospective trials to support dogmatic statements concerning the sequence and duration of therapy in the salvage setting. Although the literature offers many examples of chemotherapy studies conducted in the salvage setting, these studies typically involve relatively small numbers of younger patients whose disease shows good performance. The extrapolation of these observations to the practice setting, compounded by the clinical and molecular heterogeneity of epithelial ovarian cancer, further exacerbates the difficulties encountered in individual treatment recommendations.     

Radiotherapy with concurrent docetaxel for advanced and recurrent breast cancer

BACKGROUND: Docetaxel has shown remarkable radiosensitizing properties in vitro. In this study we investigated whether the addition of docetaxel to radiotherapy enhanced tumor response in patients with advanced or recurrent breast cancer. METHODS: A total of 35 patients were enrolled in this study. Docetaxel was administered concurrently during radiotherapy. Radiation doses were 54 to 69 Gy (median 60 Gy). In those enrolled through January 2000, docetaxel 40 mg/m2 was administered biweekly (once every two weeks), with subsequent dose adjustments based on tolerance and bone marrow and liver function. Beginning in February 2000, a weekly docetaxel schedule was used instead. This new regimen was based on data suggesting reduced myelosuppression with this regimen. The weekly dose rate was 20 mg/m2, with dose reductions for impaired organ function. RESULTS: All patients were evaluated for toxicity and response and a total of 40 irradiated sites were evaluated for local response. The overall response rate of irradiated sites was 95% and the CR rate was 68%. CR and PR were achieved in 40%, 37% of patients, respectively. Acute toxicities were tolerated by most patients: 17% had Grade 3-4 neutropenia, 6% had Grade 3-4 radiation dermatitis, and 3% had Grade 3-4 pneumonitis. CONCLUSION: The combination of docetaxel with radiotherapy is an active and safe regimen in patients with inoperable advanced or recurrent breast cancer. We determined the recommended dose of docetaxel with concomitant radiotherapy to be 20 mg/m2 weekly for a Phase II study. Further study is necessary to assess the impact of this treatment on long-term outcome.     

A pilot study of docetaxel-carboplatin versus paclitaxel-carboplatin in Japanese patients with epithelial ovarian cancer

Background It has been reported that a docetaxel-carboplatin combination as first-line chemotherapy for ovarian cancer showed a level of progression-free survival similar to that of paclitaxel-carboplatin while reducing neurotoxicity and improving quality of life. We investigated the recommended doses of docetaxel-carboplatin in Japanese patients with ovarian cancer and conducted a comparative study of docetaxel-carboplatin versus paclitaxel-carboplatin. Methods Thirty-nine patients with ovarian cancer were enrolled in this study and 38 patients were evaluated. We conducted a dose-escalation study using a docetaxel dose of 70 mg/m² and carboplatin AUC 5 and 6. In the comparative study, patients received either docetaxel 70 mg/m² and carboplatin AUC 5 or paclitaxel 175 mg/m² and carboplatin AUC 5. Progression-free survival, survival rate at 2 years, response rate, toxicity, and quality of life were investigated. Results In the dose-finding study, we determined the recommended doses as docetaxel 70 mg/m² and carboplatin AUC 5. In the comparative study, the two arms showed similar progression-free survival. Grade 4 neutropenia occurred more frequently in the docetaxel-carboplatin group (84.6%) than in the paclitaxel-carboplatin group (43.8%), while sensory neurotoxicity was less frequent in the docetaxel-carboplatin group (53.8%) than in the paclitaxel-carboplatin (68.8%) group. There were significant differences in the quality-of-life data in favor of docetaxel-carboplatin. Conclusion We determined the recommended doses of docetaxel-carboplatin for Japanese patients with ovarian cancer to be docetaxel 70 mg/m² and carboplatin AUC 5. In the comparative study, we suggest that the docetaxel-carboplatin combination is effective and well tolerated as first-line chemotherapy for Japanese patients with ovarian cancer.     

A multicenter phase II study of cisplatin and docetaxel (Taxotere) in the first-line treatment of advanced ovarian cancer: a GINECO study

Purpose A multicenter phase II study to evaluate the antitumor effect and safety of docetaxel in combination with cisplatin as first-line chemotherapy for advanced ovarian cancer.Methods Enrolled in the study were 45 patients who were to receive six courses of docetaxel 75 mg/m² plus cisplatin 75 mg/m² every 21 days with hydration and steroid prophylaxis after initial debulking surgery. Imaging techniques and radiography were used to assess clinical tumor response, and second-look surgery was required for patients with complete clinical responses and for those without clinically measurable disease.Results The overall clinical response rate in 29 patients with clinically measurable disease was 58% (41% complete response). A complete pathologic response was seen in 9 of 34 patients who underwent second-look laparotomy, while microscopic disease was found in 10 patients. The median time to progression was 14.4 months (95% CI 8.4–20.4 months), with a median overall survival of 43 months (95% CI 21.1–65.0 months). Patients received a median number of six cycles at a dose intensity of 98%. Grade 3–4 neutropenia was seen in 80% of patients, but was manageable. No patients withdrew because of fluid retention.Conclusions The combination of docetaxel with cisplatin confers high clinical and pathologically verified tumor response rates and is well tolerated in the first-line management of advanced ovarian cancer.     

复发性卵巢癌的化放疗研究

目的：分析化疗结合放疗对复发性卵巢癌治疗的疗效。方法：30例复发性卵巢癌采用铂类或紫杉醇为主的二线化疗，并根据患者肿瘤复发部位或再次手术后腹盆腔内残留病灶选用盆腔或全腹放疗。结果：平均二线化疗7个（3—14）个疗程，20例患者二线化疗后获临床完全缓解。21例患者接受了再次肿瘤细胞减灭术，16例术后残留病灶≤1cm。二线化疗期间结合放疗，23例行盆腔放疗，平均总量42．2（30．0～45．12）Gy，7例行全腹分段超分割放疗，平均总量30．2（29．96～31．2）Gy，其中4例盆腔加量至45．1（44．98～45．12）Gy。平均随访41．0个月，中位总生存时间57．0个月，患者3年、5年总生存率分别为73．33％、46．67％。复发后中位生存时间38．9个月，复发后3年生存率达56．34％。单因素和多因素分析结果提示二线化疗疗效（HR=0．26，P〈0．01）和停铂化疗间期（HR=-0．21，P〈0．01）影响复发患者的总生存期，二线化疗也是决定患者复发后生存期的独立因素（HR=0．25，P〈0．01）。结论：二线化疗是决定复发性卵巢癌生存期的重要因素，在二线化疗的基础上配合盆腔或全腹放疗可延长患者的生存期，特别是在二线化疗达临床缓解后加用放疗可提高腹盆腔局部肿瘤控制率，延缓肿瘤的再复发。     

Monoclonal antibody targeting MUC1 and increasing sensitivity to docetaxel as a novel strategy in treating human epithelial ovarian cancer

The purpose of this study was to investigate the in vitro effect of anti-MUC1 monoclonal antibody (MAb) C595 alone and in combination with docetaxel, on the growth and survival of different epithelial ovarian cancer (EOC) cell lines. MUC1 expression was assessed on EOC cell lines (OVCAR-3, IGROV-1, A2780, CAOV-3, TOV-21G, TOV-112D, SKOV-3 and OV-90) using immunofluorescence labeling and flow cytometry. The effect of MAb C595 alone or in combination with docetaxel on the cell lines was studied by proliferation, colony and TUNEL assays. Our results indicate that all primary and metastatic EOC cell lines tested were positive to MAb C595 (MUC1); MAb C595 inhibited EOC cell proliferation in a MUC1- and dose-dependent manner; low-dose MAb C595 (1/2 of IC₅₀) combined with docetaxel greatly improved efficiency of cell killing in EOC cells and induced apoptosis; the additive effect of MAb C595 was further confirmed in colony forming assays; and cell death following single or combined treatments was associated with the release of cytochrome c and increased caspase-3 activity. These results suggest that MAb C595 used either alone, or combined with docetaxel, is an attractive strategy for targeting human EOC.     

Perioperative morbidity and outcome of secondary cytoreduction for recurrent epithelial ovarian cancer

Background

Despite radical surgical and chemotherapeutic treatment of ovarian cancer, the majority of patients develop recurrent disease. Secondary cytoreductive surgery can result in favourable outcome in selected patients, but information regarding feasibility, safety and perioperative outcome of these often complex procedures is limited.

Methods

Surgical parameters in patients with recurrent epithelial ovarian cancer selected for secondary cytoreduction were analysed and compared to patients undergoing primary cytoreduction.

Results

In total, 222 patients undergoing radical cytoreduction were analysed (48 patients for relapsed disease and 174 patients at primary diagnosis of advanced ovarian cancer). The range of surgical procedures was similar in both groups. In 48% of secondary cytoreductions ‘optimal surgical results’ (residual tumour <1 cm) were obtained and 33% of the patients had no residual disease compared to 82% and 58% at primary cytoreduction. There was no significant difference in perioperative complication rates. The duration of surgery was shorter and the number of transfused blood products was smaller at secondary cytoreduction (p < 0.001 and p = 0.001).

Conclusion

Secondary cytoreduction in relapsed ovarian cancer is safe and feasible and perioperative outcome is not inferior compared to primary cytoreduction. Surgery-associated morbidity should represent a minor aspect in the selection and counselling of patients regarding treatment options for recurrent ovarian cancer.     

卵巢癌治疗后早期复发因素的探讨

背景与目的:卵巢癌易复发,目前对其尚无令人满意的有效治疗方法。本文旨在探讨卵巢癌治疗后早期复发的因素,以降低其复发率。方法:回顾性分析1986年1月至1996年5月在我院住院治疗后1年内复发的卵巢癌患者的临床资料,分别比较其不同的临床分期、病理类型、残瘤灶大小、化疗情况的复发率。统计学分析用X~2检验。结果:373例卵巢癌治疗后1年内复发者82例,复发率为22.0％。Ⅰ～Ⅱ期患者的1年内复发率低于Ⅲ～Ⅳ期患者(2.7％ vs.30.3％,P<0.01);未分化腺癌患者的复发率高于其它类型患者;残留灶≥2 cm者的复发率高于<2 cm者(33.8％ vs.13.7％,P<0.01)。术前化疗者的1年内复发率低于术前未化疗者(11.0％ vs.30.5％,P<0.01);术后化疗1～3疗程者复发率高于4～6疗程及>6疗程者(67.0％ vs.7.7％,67.0％ vs.7.0％,P<0.01)。结论:卵巢癌治疗后1年内复发大多与临床期别较晚、手术切除不彻底和化疗疗程不足有关。     

Chemotherapy in epithelial ovarian cancer

Epithelial ovarian cancer is the most common type of ovarian cancer; usually occurs in women older than 50years, and because 75% of cases are diagnosed at stage III or IV it is associated with a poor prognosis. Treatment of ovarian cancer is based on the integration of surgery and chemotherapy. Chemotherapy plays a major role both in the adjuvant treatment and in the care of patients with advanced disease. Several active drugs have been introduced in the treatment of ovarian cancer in the last decades and novel targets and agents are under evaluation.     

Optimizing treatment in recurrent epithelial ovarian cancer

Introduction: Optimal management of recurrent ovarian cancer (ROC) remains an area of uncertainty. An estimated 85% of patients with epithelial ovarian cancer who achieve a full remission following first-line therapy will develop recurrent disease and median survival for these patients’ ranges from 12 months to 24 months. Many patients receive several lines of treatment following recurrence and, although each subsequent line of therapy is characterized by shorter disease-free intervals, decisions about the most appropriate treatment is complex.

Areas covered: This review focuses on chemotherapy, surgery and emerging biologic agents that present a therapeutic option for patients with ROC.

Expert commentary: Recurrent ovarian cancer is not curable. The goals of therapy should focus on palliation of cancer-related symptoms, extension of life, and maintenance of quality of life. Patients with platinum-sensitive ovarian cancer should have their recurrence treated with a platinum-based agent. For patients whose cancer progresses after platinum retreatment and for those with platinum-resistant disease, numerous other non-platinum combination and targeted therapies have been shown to be effective in palliating cancer-related symptoms and extending life.     

Salvage hypofractionated radiotherapy for biochemically recurrent prostate cancer after radical prostatectomy

PURPOSE: To evaluate whether hypofractionation is well tolerated and to preliminarily assess biochemical control of this regimen in a postprostatectomy, salvage setting. METHODS AND MATERIALS: A retrospective analysis was performed in 50 patients treated between May 2003 and December 2005 with hypofractionated radiotherapy for biochemical recurrence after radical prostatectomy. Radiotherapy was prescribed to the prostatic fossa to 65-70 Gy in 26-28 fractions of 2.5 Gy each, using intensity-modulated radiotherapy with daily image localization. Toxicities were scored using a modified Radiation Therapy Oncology Group scale and the Fox Chase modification of Late Effects Normal Tissue scale. The median follow-up was 18.9 months (range, 5.3-35.9). RESULTS: No Grade 3 or greater acute or late toxicities were observed. Grade 2 toxicities included four acute genitourinary, one acute gastrointestinal, two late genitourinary, and two late gastrointestinal toxicities. Of the 50 patients, 39 demonstrated a continuous biochemical response after salvage therapy, 3 had an initial response before prostate-specific antigen failure, and 7 had prostate-specific antigen progression, 1 of whom died of progressive metastatic disease. Finally, 1 patient discontinued therapy because of the diagnosis of a metachronous pancreatic cancer and died without additional prostate cancer follow-up. All remaining patients were alive at the last follow-up visit. A lower presalvage prostate-specific antigen level was the only significant prognostic factor for improved biochemical control. The estimated actuarial biochemical control rate at 2 years was 72.9%. CONCLUSIONS: The toxicity and early biochemical response rates were consistent with expectations from conventional fractionation. Additional follow-up is required to better document the biochemical control, but these results suggest that hypofractionation is a well-tolerated approach for salvage radiotherapy.     

提高复发性卵巢上皮癌手术切除率的探讨

背景与目的:复发性卵巢上皮癌能否手术切除对预后影响较大,提高复发性卵巢上皮癌的手术切除率有助于改善其预后。本研究旨在探讨如何提高复发性卵巢上皮癌的手术切除率。方法:回顾性分析1997年3月1日至2003年3月31日期间因复发性卵巢上皮癌在我院行第二次细胞减灭术的54例病例的临床资料。其中病灶部位局限于盆腔19例,超出盆腔35例。病灶数目为1个者16例,≥2个者38例。无腹水38例,有腹水16例。接受术前化疗20例,有效12例,无效8例。以 Logistic多因素回归,分析年龄、复发间隔时间、复发病灶部位、数目、有无腹水及复发术前化疗对复发术后残留灶的影响。结果:肿瘤的满意切除率为81.5％(44/54),其中无残留灶者占53.7％(29/54),残留灶≤2 cm者占27.8％(15/54)。Logistic分析显示,病灶部位及有无腹水是影响复发术后残留灶的显著性因素(P<0.05);复发术前化疗有效和无效患者的满意切除率分别为100％(12/12)和37.5％(3/8),卡方检验显示两者有非常显著性差异(P<0.01)。本组40.7％(22/54)的患者手术较复杂,涉及胃肠道、泌尿道或肝脾。术后并发症发生率为16.6％(9/54),手术死亡率1.9％(1/54)。结论:根据患者瘤灶的边界、部位、有无腹水及术前化疗的疗效,对复发患者进行适当的选择,并作好充分的术前准备有助于提高复     

Chemotherapy with pegylated liposomal doxorubicin and cisplatin in recurrent platinum-sensitive epithelial ovarian cancer

BACKGROUND: Pegylated liposomal doxorubicin (PLD) is the only nonplatinum agent to significantly improve survival in patients with platinum-sensitive recurrent ovarian cancer. The present study was designed to assess the efficacy and safety of PLD plus cisplatin combination therapy in these patients. METHODS: Twenty-two women (median age, 57 years) with ovarian cancer that recurred 6 months or more after standard carboplatin and paclitaxel therapy were eligible for enrollment. Cisplatin was administered intravenously as a 60-min infusion on day 1, at a single dose of 60 mg/m(2), and PLD was given intravenously as a 1-h infusion on day 2, at a dose of 50 mg/m(2). Treatment cycles were repeated on an outpatient basis every 28 days. RESULTS: Hematological toxicity was mainly leucopenia/neutropenia, and this was the principal dose-limiting toxicity. Severe (grade III-IV) leucopenia/neutropenia was observed in 7 (32%) and 9 (41%) patients, respectively. Only 2 (9%) patients were complicated by febrile neutropenia. Grade III-IV anemia occurred in only 4 (18%) patients. Severe thrombocytopenia was not noted; only 5 patients (23%) had grade I-II toxicity. NO toxicity in biochemical parameters was noted. Several severe nonhematological adverse effects were managed according to standard protocols and were transient, as well as being well-tolerated. Twenty-one patients were evaluated for response. The overall response rate was 62% (13 of 21; 95% confidence interval [CI], 38%-82%), with four (19%) complete and nine (43%) partial responses. At the time of last follow-up, all of the 22 patients were alive. The median follow-up period was 8.5 months (range, 2 to 22 months). CONCLUSION: PLD combined with cisplatin at the schedule and dosage used in this study is an active and safe second-line chemotherapy regimen with acceptable and easily manageable toxicities in women with platinum-sensitive recurrent ovarian cancer.     

复发性卵巢上皮癌二次肿瘤细胞减灭术研究进展

对于复发性卵巢上皮癌患者采用二次肿瘤细胞减灭术(STRS)及后续药物治疗能延长生存期,提高生活质量,手术范围以最大限度切除复发灶为原则,STRS后残存肿瘤的大小是影响预后的主要因素。现综述复发性卵巢上皮癌STRS的类型和适应证、手术方式及临床价值。     

A phase II study of docetaxel as salvage chemotherapy in advanced gastric cancer after failure of fluoropyrimidine and platinum combination chemotherapy

Purpose Fluoropyrimidine (F) and platinum (P) combination chemotherapy has been widely used as a first-line treatment of advanced gastric cancer (AGC). Docetaxel has shown promising activity against this disease. In this study, we explored the efficacy and safety of docetaxel monotherapy as salvage chemotherapy in AGC after F and P combination chemotherapy failed. Materials and methods From October 2004 to October 2005, 49 eligible patients were enrolled in this study. The median treatment-free interval was 28.0 days, and 81.6% of patients had suffered cancer progression within 4 months after the withdrawal of first-line chemotherapy. Docetaxel was given IV at a dose of 75 mg/m² every 3 weeks, together with dexamethasone prophylaxis. Results A total of 182 cycles of docetaxel were administered with a median of 3 (range 1–9) cycles. From an intention-to-treat analysis, eight patients achieved objective response with a response rate of 16.3% (95% CI, 6.0–26.6). The median response duration was 4.7 months. A total of 20 patients showed stable disease, but 17 patients suffered disease progression. At a median follow-up duration of 11.3 months for surviving patients (range 6.3–18.8 months), the median time to disease progression was 2.5 months (95% CI, 2.3–2.7) and the median overall survival time since the start of docetaxel monotherapy was 8.3 months (95% CI, 6.7–9.8). Grade 3/4 neutropenia and febrile neutropenia occurred in 18.4% of patients and in 5.4% of cycles. The incidence of non-hematologic toxicities of grade 3 or worse was asthenia 32.7%, diarrhea 10.2% and peripheral sensory neuropathy 8.2%. Conclusion Docetaxel at 75 mg/m² is active against AGC as second-line chemotherapy after prior exposure to F and P combination chemotherapy. The toxicity profile is moderate.     

The efficacy of tamoxifen in patients with advanced epithelial ovarian cancer

Background: Activity of tamoxifen as a salvage therapy in patients with advanced epithelial ovarian cancer was evaluated by a number of studies. In this study, we evaluated efficacy of tamoxifen in our patients with platinum-resistant epithelial ovarian carcinoma. Patients and Methods: A retrospective analysis was conducted of patients who received tamoxifen at a dose 20 mg twice daily for the treatment of advanced epithelial ovarian cancer. Results: Twenty-nine eligible patients were included to the study. There were 1 (3%) complete response, 2 (7%) partial response, 6 (21%) stable disease, and 20 (69%) progressive disease. All patients were progressed after initiation of tamoxifen. Median progression-free survival was 4 mo (95% CI: 2.98–5.02). Disease progression of 19 (65%) patients were shown within the first 6 mo after initiation of tamoxifen. Progression-free survival was between 6 and 12 mo for 7 (24%) patients and ≥ 12 mo for 3 (10%) patients. The median survival after initiation of tamoxifen was 15 mo (95% CI: 7.2–22.8). No toxicity attributable to tamoxifen was seen in any of the patients. The only independent prognostic factor that had a significant predictive value for progression-free survival was the response to tamoxifen treatment (p=0.043, hazard ratio: 0.12, 95% CI: 0.01–0.94). Conclusion: Considering minimal side effects and ability to cause objective responses, there is a place for tamoxifen in treatment of patients with platinum-resistant ovarian cancer. A phase III trial is required to confirm the value of the drug in patients presenting these clinical settings.     

Maximal cytoreductive effort in epithelial ovarian cancer surgery

The surgical management of advanced epithelial ovarian cancer involves cytoreduction, or removal of grossly-evident tumor. Residual disease after surgical cytoreduction of ovarian cancer has been shown to be strongly associated with survival. The goal of surgery is "optimal" surgical cytoreduction, which is generally defined as residual disease of 1 cm or less. However, the designation of "optimal" surgical cytoreduction has evolved to include maximal surgical effort and no gross residual disease. In order to achieve this, more aggressive surgical procedures such as rectosigmoidectomy, diaphragm peritonectomy, partial liver resection, and video-assisted thoracic surgery are reported and increasingly utilized in the surgical management of advanced ovarian cancer. The role of maximal surgical effort also extends to the recurrent setting where the goal of surgery should be complete cytoreduction. Patient selection is important in identifying appropriate candidates for surgical cytoreduction in the recurrent setting. The purpose of this article is to review the role of maximum surgical effort in primary and recurrent ovarian cancer.     

Risk of epithelial ovarian cancer in relation to benign ovarian conditions and ovarian surgery

Objective  Some forms of ovarian neoplasms may be preventable through the removal of precursor lesions. We assessed the risk associated with a prior diagnosis of, and ovarian surgery following, ovarian cysts and endometriosis, with a focus on characterizing risk among tumor subgroups. Methods  Information was collected during in-person interviews with 812 women with ovarian cancer diagnosed in western Washington State from 2002 to 2005 and 1,313 population-based controls. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results  The risk of a borderline mucinous ovarian tumor associated with a history of an ovarian cyst was increased (OR=1.7, 95% CI: 1.0–2.8), but did not vary notably according to receipt of subsequent ovarian surgery. While risk of invasive epithelial ovarian cancer was slightly increased among women with a cyst who had no subsequent ovarian surgery, it was reduced when a cyst diagnosis was followed by surgery (OR = 0.6, 95% CI: 0.4–0.9). This reduction in risk was most evident for serous invasive tumors. Women with a history of endometriosis had a threefold increased risk of endometrioid and clear cell invasive tumors, with a lesser risk increase among women who underwent subsequent ovarian surgery. Conclusions  Our results suggest differences in the relation of ovarian cysts and endometriosis with risk of specific subtypes of ovarian cancer as well as the possibility that ovarian surgery in women with these conditions may lower the risk of invasive disease. Funding for this work was provided by the National Institutes of Health (RO1 CA87538).     

3-Hour infusion of single-agent paclitaxel for recurrent ovarian cancer

Background. The clinical response, survival, and toxicity of a 3-h infusion of single-agent paclitaxel (175 mg/m²) for Japanese patients with recurrent ovarian cancer were investigated. We also examined whether or not cancer antigen (CA) 125 would be suitable as an indicator of the effects of the paclitaxel on ovarian cancer. Methods. Twenty-one patients clinically diagnosed as having recurrent ovarian cancer met the entry criteria, agreed to participate in this study, and received the treatment. Results. One hundred and twenty-six courses were administered to the 21 patients. One patient achieved a complete response, and 5 a partial response; the overall response rate was 35.3%. Using CA125 criteria, 42.1% of patients achieved a response. The median progression-free interval was 4.4 months, and the median overall survival time was 14.5 months. While hematological toxicity was not severe, 3 patients experienced severe peripheral neuropathy, and 2 patients experienced grade 4 myalgia/arthralgia. Conclusion. The 3-h infusion of single-agent paclitaxel (175 mg/m²) was an effective treatment for patients with recurrent ovarian cancer. CA125 was a useful indicator of the response to the treatment. While peripheral neuropathy and the myalgia/arthralgia were severe, 3-h infusion of single-agent paclitaxel offers a promising treatment for recurrent ovarian cancer. Received: December 11, 2000 / Accepted: March 30, 2001     

复发卵巢上皮性癌的治疗与预后分析

Objective To discuss the prognostic factors of recurrent ovarian epithelial carcinoma and to analyze the curative effect of post-relapse treatment.Methods The clinical records of 293 patients with ovarian epithelial carcinoma were reviewed retrospectively.There were 199 recurrent cases during the following up.Results All the 199 patients received chemotherapy.And 173 patients only received chemotherapy.16 patients received surgery and chemotherapy and the other 10 patients received radiotherapy and chemotherapy.158 patients received platinum-based chemotherapy again and 41 patients received chemotherapy without platinum.The response rate of all the patients was 43.7%(87/199),the response rate of only chemotherapy was 39.9%(69/173),the response rate of surgery and chemotherapy was 75.0%(12/16),and the response rate of radiotherapy and chemotherapy was 60.0%(6/10).The patients were divided into four groups according to the progression free interval(PFI).The response rates in groups that PFI ≤6 months,7-12 months,13-24 months and ＞24 months were 5.1%,47.2%,82.1% and 96.0%,respectively.The median survival time in the 16 patients received second cyto-reductive surgery was 41 months.Multivariate analysis revealed that PFI was significantly correlated with prognosis of recurrent ovarian epithelial carcinoma(OR =0.589,P =0.021).Conclusion PFI is an individual prognostic factor for survival of recurrent ovarian epithelial carcinoma.PFI is significantly associated with the response rate of chemotherapy.Optimal secondary cytoreductive surgery may improve the overall survival of recurrent patients.The response rate of paclitaxel plus platinum chemotherapy in platinum-sensitive patients is higher than that of other platinum-based chemotherapy.