三种化疗方案治疗晚期上皮性卵巢癌的疗效比较

目的 :确定治疗晚期上皮性卵巢癌的最佳一线化疗方案。方法 :回顾性分析 1992年 1月至 1999年 1月收治的晚期上皮性卵巢癌患者的治疗结果。对采用 PAM加 HMM(米法兰加六甲咪胺 )、PAC方案或 PC方案及 TP方案治疗的 92例患者的化疗疗效进行了比较。结果 :1TP方案的总有效率显著高于 PAM加 HMM(P<0 .0 5 ) ;2 TP方案的完全缓解率显著高于 PAM加 HMM和 PAC或 PC(P<0 .0 5 ) ;3TP方案的 2年无瘤存活率显著高于 PAM加 HMM和 PAC或 PC(P<0 .0 5 )。结论 :对晚期上皮性卵巢癌患者 ,TP方案效果优于 PAM加 HMM方案及 PAC和 PC方案 ,目前应作为首选一线方案     

上皮性卵巢癌的一线化疗

化疗是上皮性卵巢癌主要的辅助治疗手段,铂类为基础的联合化疗是上皮性卵巢癌的一线化疗方案,但在药物组成、剂量强度、给药方式、腹腔化疗、新辅助化疗及维持和巩固治疗方面仍值得进一步探索。     

紫杉醇剂量密度方案化疗在上皮性卵巢癌应用的疗效及安全性meta分析

目的:评价紫杉醇剂量密度化疗方案治疗上皮性卵巢癌(EOC)的疗效及安全性。方法:采用计算机检索Cochrane图书馆、Pub Med、Embase、ASCO、中国生物医学文献数据库、中国期刊全文数据库、万方数据库中从建库至2014年12月31日关于紫杉醇周疗治疗上皮性卵巢癌与传统月疗方案比较的临床随机对照试验。由两名评价者独立按Cochrane系统评价手册5.1版推荐的RCT标准评价纳入研究的质量,并采用Cochrane协作网提供的Rev Man 5.3软件进行Meta分析,无进展生存期(PFS)及总生存期(OS)合并统计量为风险比(HR),不良反应合并统计量为相对危险度(RR)。结果:纳入5项随机对照试验共2589例患者。Meta分析结果显示,与传统化疗方案相比,紫杉醇周疗在PFS(HR=0.91,95%CI 0.83~1.01)及OS(HR=1.01,95%CI 0.81~1.25)上并未显示明显优势。安全性分析显示,紫杉醇周疗方案发生贫血的风险较传统方案高(RR=1.32,95%CI 1.00~1.75),但对关节痛/肌痛具有保护作用(RR=0.70,95%CI 0.59~0.83)。结论:目前证据表明,紫杉醇周疗相较于传统3周疗法并未在改善患者OS及PFS上显示明显优势,但由于纳入文献较少,故需对此结论持审慎态度。尚需进一步开展大规模、高质量的临床研究进行证实。由于两种方案的不良反应谱不同,仍可以为临床提供参考意义。     

初诊上皮性卵巢癌的一线化疗

晚期上皮性卵巢癌的初始治疗模式为肿瘤细胞减灭术+铂类为基础的联合化疗+一线维持治疗.文章主要阐述了初诊上皮性卵巢癌一线化疗方案的演变和规范应用.紫杉醇联合卡铂3周疗方案仍然是初治上皮性卵巢癌的一线首选化疗方案,其卓越地位无法撼动.同时,文章还回顾了初始化疗中使用贝伐珠单抗的指征,以及其他一线化疗方案的选择指征.最后,文...     

上皮性卵巢癌保留生育功能治疗

早期上皮性卵巢癌预后良好。保留生育功能治疗是年轻希望生育患者的选项之一,但要严格掌握适应证,规范治疗,以达到理想的预后和良好的妊娠结局。     

激素与上皮性卵巢癌

上皮性卵巢癌(epithelial ovarian cancer,EOC)占卵巢恶性肿瘤的85%～90%,5年生存率仅25%～30%左右.近年来已证明某些EOC组织能分泌多种激素并具有多种激素受体,流行病学和实验研究证明EOC的发生、发展和预后与激素及其受体关系密切.随着对EOC与激素及其受体的深入研究,激素辅助治疗可能会带来卵巢癌治疗的新发展.     

端粒酶激活与上皮性卵巢癌化疗敏感性及其预后的关系

目的：探讨端粒酶活性水平对卵巢化疗疗效及预后影响。方法：以TRAP－PCR－ELISA法检测卵巢癌组织中端粒酶活性;以MTT法检测卵巢癌细胞对CDDP、ADM敏感。结果：22例卵巢癌组织中,端粒酶阴性者3例（13．64％）,阳性者19例（86．36％）。8例端粒酶活性高于2U者,PAC方案化疗有效者5例（62．5％）,11例端粒酶活性低于2U者,化疗均有效（100％）。端粒酶活性高于2U者,进展与复发或死亡5例（62．5％）,而端粒酶活性低于2U者仅1例出现复发,无死亡。结论：随着端粒酶活性增高,卵巢癌对CDDP、ADM敏感性下降。     

上皮性卵巢癌治疗进展

既往大多数被诊断为晚期上皮性卵巢癌(EOC)的患者都尝试了初次减瘤术后联合化疗。然而,对于无法进行初次减瘤术的晚期EOC患者,新辅助化疗后的间歇性肿瘤减瘤手术是一种替代治疗方法。目前对于EOC新辅助化疗又存在新的争议,对影响治疗的基因突变进行基因检测是所有EOC女性的治疗标准。使用聚ADP-核糖聚合酶抑制剂、贝伐珠单抗和(或)靶向同源重组缺陷药物的维持治疗在EOC的治疗中得到了越来越广泛的应用,为EOC患者带来了新的治疗策略。     

上皮性卵巢癌二线化疗

<正>上皮性卵巢癌是女性生殖系统最常见的恶性肿瘤之一,70%就诊时为晚期。初始经过肿瘤细胞减灭术及术后辅以铂类为基础的化疗,70%左右的患者在经过一段缓解期后会出现复发[1]。美国国家综合癌症网络(NCCN)根据无铂治疗间期(platinum-free interval,PFI),将从初次铂类化疗结束到复发PFI超过6个月以上患者称为铂类敏感复发,反之为铂类耐药复发[2]。世界卫生组织(WHO)已将癌症作为"慢性疾病",并基于此将恶性肿瘤     

CAP方案治疗卵巢上皮性癌127例远期疗效分析

目的 :评价接受CAP方案 (环磷酰胺、卡铂 /顺铂、阿霉素 )治疗卵巢上皮性癌 12 7例的远期疗效。方法 :回顾分析 12 7例手术及病理证实的卵巢上皮性癌I～IV期患者手术后接受CAP方案化疗的疗效。比较各期、各病理类型患者术后复发率及生存率。结果 :Ia、Ib～c、II、III期患者术后 8年生存率分别为 10 0 %、87.9%、36 .1%、34.8% ;复发率分别为 4 3.5 %、32 .1%、81.9%、89.2 %。IV期患者 4年生存率为 2 7.0 % ,复发率为10 0 %。II～IV期卵巢透明细胞癌术后 1年生存率为 15 .6 % ,与浆液性、粘液性和内膜样卵巢腺癌 89.2 %的 1年生存率相比差异有显著性 (P =0 .0 10 8)。结论 :CAP方案仍可作为卵巢上皮性癌常规治疗的方案 ,但对透明细胞癌、铂类治疗后复发性癌及IV期卵巢上皮性癌效果不佳     

A phase I study of paclitaxel, topotecan, cisplatin and Filgrastim in patients with newly diagnosed advanced ovarian epithelial malignancies: a Gynecologic Oncology Group study

OBJECTIVES: To determine a recommended dose level (RDL) of paclitaxel, cisplatin and topotecan in women with previously untreated epithelial ovarian or peritoneal cancer as a possible experimental arm in a future Gynecologic Oncology Group phase III study. METHODS: Patients with newly diagnosed stage III or IV disease were treated with paclitaxel 175 mg/m2/3 h, followed 2 h later by cisplatin 50 mg/m2 on day 1. Topotecan was administered on consecutive days as a 30-minute infusion, beginning after cisplatin on day 1, receiving either 5 days beginning at 0.3 mg/m2 (cohort 1), or 3 days beginning at 0.5 mg/m2 (cohort 2). Treatment was given every 21 days for a maximum of 8 cycles. RESULTS: Forty-five evaluable patients were enrolled in the two cohorts. Thrombocytopenia and prolonged neutropenia were the major dose-limiting toxicities. Dose-limiting neutropenia was seen at the first dose level, thus all subsequent dose escalations included Filgrastim. The RDL of cohort 1 was paclitaxel 175 mg/m2/3 h, cisplatin 50 mg/m2 and topotecan 0.5 mg/m2 daily x 5 with Filgrastim. The RDL of cohort 2 was paclitaxel 175 mg/m2/3 h, cisplatin 50 mg/m2 and topotecan 0.75 mg/m2 daily x 3 with Filgrastim. CONCLUSION: In women with previously untreated epithelial ovarian or peritoneal cancer the combination of paclitaxel, cisplatin and topotecan is feasible. However, this treatment requires the use of Filgrastim and attenuated dosing of topotecan in both a 5-day and 3-day topotecan infusion schedule.     

First-line intraperitoneal carboplatin-based chemotherapy for 165 patients with epithelial ovarian carcinoma: results of long-term follow-up

OBJECTIVE: Currently, no long-term follow-up data are available on intraperitoneal (IP) carboplatin-based chemotherapy for ovarian carcinoma. In this study we evaluated retrospectively the survival and recurrence of a retrospective cohort of patients with epithelial ovarian cancer treated with first-line IP carboplatin-based therapy. METHODS: Records were reviewed of 174 patients with epithelial ovarian cancer who received IP carboplatin-based therapy between 1990 and 2000. All patients underwent surgical staging, and implantable port systems were placed regardless of residual tumor size. The pathological slides were submitted and reviewed, and then nine patients were excluded because of borderline malignancies (n = 8), and wrong histology (n = 1). Therefore, the records of 165 patients were analyzed for survival. Tumor grade was determined by the Universal grading system. Statistical analysis included tests for association between potential prognostic factors, and between prognostic factors and survival. Survival probabilities were estimated by Kaplan-Meier methods, and prognostic factors for survival were evaluated by a Cox regression model. RESULTS: The mean age of the patients was 53.7 years (range 21-83). The median follow-up was 41 months. The distribution by stage and histology was as follows: high risk (grade 2/3, clear cell, capsule rupture) stage I, 54; II, 21; III, 72; IV, 18; and serous, 75; clear cell, 30; mucinous, 27; endometrioid, 20; others, 13. The chemotherapy regimen was either carboplatin alone (n = 22) or in combination with cyclophosphamide (n = 116) or paclitaxel (n = 27). Catheter-related complications occurred in 16 (9.7%) cases. The chemotherapeutic response in 54 patients with measurable disease was 66.4%. The 5-year survival was 94.4% for stage I, and 87.9% for stage II. The median survival for optimal and suboptimal stage III/IV patients was 51 months and 34 months, respectively. The median survival of patients with stage III/IV disease was 51 months with carboplatin doses of 400 mg/m(2) or more, but it was only 25 months with carboplatin doses smaller than 400 mg/m(2). Poor prognostic factors, determined by Cox regression multivariate analysis, were clear cell histology (P < 0.001) and a carboplatin dose smaller than 400 mg/m(2) (P = 0.002). CONCLUSIONS: Survival of patients who underwent carboplatin-based IP chemotherapy was excellent when the dose of carboplatin was higher than 400 mg/m(2). A prospective evaluation of IP carboplatin therapy with modern combination is warranted.     

A phase II trial of paclitaxel poliglumex in recurrent or persistent ovarian or primary peritoneal cancer (EOC): a Gynecologic Oncology Group Study

ObjectivesTo estimate the anti-tumor activity and toxicity of paclitaxel poliglumex (PPX) in patients with persistent or recurrent ovarian, fallopian tube or primary peritoneal cancer (EOC) in second or third line treatment.MethodTwenty-five patients received PPX at 235 mg/m² every 21 days (Cohort 1). At a planned analysis following first stage accrual, the dose was reduced to 175 mg/m² Cohort 2) for additional accrual to 78 patients. RECIST and CTC toxicity criteria were used.ResultsPatients received PPX in the second line (15%) and third line (85%) setting. In cohort 2, 25 out of 47 determined cases (53%) were platinum resistant and 17 out of 43 determined cases (40%) were taxane-resistant. The overall response rates for cohort 2 were 0/49 (0%) CR, 8/49 (16%) PR, and 20/49 (41%) SD. The median progression-free survival (PFS) was 2.8 months (95% CI 1.48–4.8 months) and median overall survival (OS) was 15.4 months. The most frequent grade III or IV toxicities in cohort 2 were: neutropenia (24%/20%), constitutional (8%/0%), gastrointestinal (6%/0%), and neuropathy (24%/0%).ConclusionPPX at 175 mg/m² every 21 days has a modest activity of limited duration when given as second or third line therapy in patients with epithelial ovarian or primary peritoneal cancer. The incidence of neuropathy using this dose in recurrent ovarian cancer is higher than predicted from studies in other tumors with PPX. The Gynecology Oncology Group (GOG) is currently exploring its use at 135 mg/m² every 28 days in a randomized trial evaluating maintenance chemotherapy in first remission.     

Economic impact of paclitaxel shortage in patients with newly diagnosed ovarian cancer

Objective

To determine the potential economic impact of a paclitaxel drug shortage in patients with newly diagnosed, untreated ovarian cancer.

Methods

A modified Markov state transition model with a 6 cycle time horizon compared two scenarios: (1) Standard treatment (STD): paclitaxel 175 mg/m2/carboplatin AUC 5 × 6 cycles; (2) Paclitaxel drug shortage (DS): docetaxel 75 mg/m2/carboplatin AUC 5 × 6 cycles. Adverse events, quality of life, and costs of chemotherapy, neuropathy, febrile neutropenia, and anemia were incorporated. Key assumptions: (1) Costs and consequences were assigned only to grade 2 + neuropathy, febrile neutropenia, and grade 3-4 anemia; (2) Grade 2 + neuropathy prompted a switch from paclitaxel/carboplatin to docetaxel/carboplatin or from docetaxel/carboplatin to carboplatin alone; (3) Febrile neutropenia resulted in inpatient hospitalization followed by G-CSF prophylaxis.

Results

The mean cost of 6 cycles of chemotherapy was $4939 in the STD and $16,107 in the DS scenario, for a cost difference of $11,168 per patient over 6 cycles of treatment. STD was the dominant strategy (less expensive and more effective than the drug shortage scenario). In sensitivity analysis, DS was more costly over a wide range of clinical estimates in each arm. A drug shortage that affects approximately 50% of women initiating chemotherapy is expected to impact 779 women and cost third party payers an additional $8,699,872 monthly.

Conclusions

Our model indicates that chemotherapy drug shortages can have a significant negative impact on the average cost of primary treatment for ovarian cancer and have the potential to negatively impact health system costs.     

卵巢上皮性癌脑转移四例临床分析

目的 探讨卵巢上皮性癌脑转移的发生率,相关因素,诊断和治疗方法。方法 分析１９８９年至１９９７年,卵巢上皮性癌１３２例,其中４例发生脑转移。结果 脑转移发生率为３％,脑争生与晚期癌和肿瘤分化程度有关,与肿瘤病理类型无关。晚期患者接受肿瘤细胞减灭术和系统化疗后生存时间延长;出现腹腔外转移者,脑转移发生率增高。     

Advanced (>second) line chemotherapy in the treatment of patients with recurrent epithelial ovarian cancer

Objective

To explore the pattern of chemotherapy (beyond the second-line) used to treat patients with recurrent epithelial ovarian cancer (including primary peritoneal carcinoma).

Study design

This retrospective study included 156 patients with recurrent epithelial ovarian cancer and primary peritoneal carcinoma who were treated in the Gynecologic Oncologic Department at Meir Medical Center between November 1995 and December 2003. Clinical characteristics and data regarding the surgery, chemotherapy, and response to treatment were abstracted from the patients’ medical records to determine patient response to advanced lines of chemotherapy for recurrent epithelial ovarian cancer.

Results

Of the 156 patients, 63 (40%) were treated beyond second-line chemotherapy. Clinical response to third-line chemotherapy was 11.9% (6.8% had complete clinical response and 5.1% partial clinical response) and 3.4% had stable disease. A total of 17% did not show immediate progression, with a median progression free-interval of 1.5 months. A drastic decline in clinical response rates was shown beyond third-line chemotherapy. Any response to treatment in more advanced lines was consistently under 5%.

Conclusion

These results imply that advanced lines of chemotherapy are associated with low response rates, although a small percentage of patients showed some clinical response or remained with stable disease at the end of treatment. Along with patient preferences, the advantages and disadvantages of continued therapy should be considered, for the side effects of each treatment cannot be overlooked.     

复发性卵巢上皮癌二次细胞减灭术62例分析

目的 探讨复发性卵巢上皮癌二次细胞减灭术的意义及可行性。方法 62例复发性卵巢上皮癌接受了二次细胞减灭术。其中48例手术成功，14例仅做探查术。术式包括部分肠切除、肠修补、脾切除、残余大网膜切除及其它转移瘤切除。仅作探查术者是由于转移癌浸润大血管及胰十二指肠等重要脏器，肠系膜呈蜡肠状等。术后辅以铂剂为主的联合化疗。结果 残余瘤直径小于2cm的27例2年和5年存活率分别为40．7％及14．8％。残余瘤大于2cm的35例只有1例存活超过2年（2．9％）。结论 成功的二次肿瘤细胞减灭术能提高患者的存活率。术前作好检查筛去不适合手术病例会提高成功率。