子宫内膜癌化疗进展

化疗是晚期或复发性子宫内膜癌的主要治疗方式。化疗在高危子宫内膜癌中的作用已引起重视。临床研究GOG209将卡铂/紫杉醇(carboplatin and paclitaxel,TcP)与子宫内膜癌标准化疗方案阿霉素/紫杉醇/顺铂联合化疗(doxorubicin,paclitaxel and cisplatin,TAP)进行比较,其结果值得期待。放疗联合化疗可以改善高危早期患者的生存。续贯化疗-放疗-化疗模式(chemotherapy,interval radiation and further chemothera-py,CRC)有利于改善晚期子宫内膜癌患者的生存。需重视化疗的毒副作用,序贯双联疗法(卡铂/紫杉醇和卡铂/阿霉素)是一种降低药物毒性的策略。     

子宫内膜癌的化疗与内分泌治疗

文章总结了子宫内膜癌术后辅助化疗、术前新辅助化疗和内分泌治疗等问题。术后辅助化疗主要用于晚期子宫内膜癌及早期患者术后具有高危因素的病例。铂与紫杉醇联合应用是目前子宫内膜癌辅助治疗的首选方案。新辅助化疗主要应用于晚期病例,以使随后的减瘤术顺利完成。内分泌治疗虽然没有得到肯定,但是在晚期病例经常用到。     

复发性子宫内膜癌的临床特征及治疗现状

复发性子宫内膜癌是指子宫内膜癌经系统的初始治疗完全缓解一段时间后 ,临床又发现癌灶 ,且组织病理类型与原发灶完全一致。文献报道 ,子宫内膜癌治疗后复发率为15 4 % [1] 。近年来研究发现 ,化学药物治疗 (化疗 )对晚期、复发性子宫内膜癌有一定疗效 ,放射治疗 (放疗 )和手术可使部分晚期、复发性子宫内膜癌患者病情缓解 ,预后改善。现就复发性子宫内膜癌的临床特征及治疗现状作一综述。一、复发性子宫内膜癌的临床特征(一 )复发的相关因素1 年龄 :多年来 ,多数学者认为年龄是影响子宫内膜癌预后的独立因素[2 ] ,而另有一些学者则认为不…     

子宫内膜癌的化疗及进展

子宫内膜癌以手术和放射治疗为主，化疗多用于晚期或复发性子宫内膜癌，可与手术、放疗或孕激素治疗联合应用。     

子宫内膜癌化疗新进展

子宫内膜癌是妇科三种常见恶性肿瘤之一,近年发病率有升高趋势。由于发现时多属早期,因此总体预后良好。早期子宫内膜癌以手术治疗为主,但特殊类型癌、晚期及复发性子宫内膜癌需辅以化疗以增加治愈率及延长生存期。现将子宫内膜癌化疗的适应征及最佳化疗方案的选择和疗效的研究进展作一综述。     

复发性子宫内膜癌的诊断与治疗进展

复发性子宫内膜癌通常发生于初始治疗后2~3年。初治后通过妇科检查、血清CA125检测以及影像学检查等手段来实现子宫内膜癌复发的早期诊断。复发性子宫内膜癌的治疗手段包括手术、放疗、激素治疗、化疗、基因靶向治疗以及生物分子制剂,复发病灶的位置和范围、患者体力状态、初始治疗史、肿瘤组织病理学类型和分级及激素受体情况等因素主要决定了复发性子宫内膜癌的治疗方法的综合选择和治疗方案的个体化制定。     

靶向治疗对复发性耐药性卵巢癌的治疗价值

卵巢癌复发率高,预后差,多数患者在反复间断化疗后最终都会出现耐药。近年来靶向药物在复发性耐药性卵巢癌的临床试验中取得了较为可喜的结果。广泛研究的靶向药物有血管内皮生长因子受体抑制剂如贝伐单抗,DNA损伤修复抑制剂如奥拉帕尼、Veliparib,血管生成素抑制剂如Trebananib,叶酸受体抑制剂如Vintafolide等等。近期研究显示,这些药物可延长铂耐药卵巢癌患者的无疾病间期。其中贝伐单抗联合单药化疗是目前临床应用较为成熟的治疗方案。文章重点介绍靶向治疗在复发性耐药性卵巢癌临床研究中的最新进展。     

复发性卵巢癌的治疗选择——手术还是化疗

复发性卵巢癌的治疗是妇科肿瘤中棘手的问题,一般包括再次手术和挽救化疗.对铂类敏感的复发性卵巢癌,可以在二次肿瘤细胞减灭术的基础上,再使用铂类为基础的联合化疗方案.对铂类耐药的复发性卵巢癌,根据患者的具体情况,权衡手术和化疗的利弊,挽救化疗时宜选择其他二线化疗药物进行单药序贯化疗.对复发性卵巢癌手术,要严格选择、充分准备,尽可能完全切除复发癌灶,为挽救化疗创造有利条件.     

铂敏感复发性卵巢癌维持治疗药物的研究进展

卵巢癌作为妇科疾病中预后最差的恶性肿瘤,发病较为隐匿,临床早期诊断难度大。对卵巢癌患者行全面分期手术辅以铂类或紫杉醇的药物化疗的标准治疗方案后,复发率极高,复发患者在多次化疗后易产生铂类药物耐药性,治疗效果愈发低下。因此,如何减少肿瘤复发、延长患者生存时间、提高生存质量一直是临床治疗卵巢癌的难点。对于铂敏感复发性卵巢癌患者,需对其在进行手术加化疗后采取维持治疗,通过抗血管生成药物、多腺苷二磷酸核糖聚合酶[poly（ADP-ribose）polymerase,PARP]抑制剂等分子靶向药物维持患者化疗后疗效,以延长患者无进展生存期及延迟复发,改善生存率及生活质量。综述目前有关铂敏感复发性卵巢癌维持治疗的相关药物治疗方法,展望维持治疗在铂敏感复发性卵巢癌治疗中的应用前景。     

复发性子宫颈癌化疗的研究进展

子宫颈癌是严重危害妇女健康的恶性肿瘤之一。复发性子宫颈癌治疗困难,预后极差,全身化疗作为一种姑息性疗法以延长生存和提高生活质量为目标,近年来以铂类和非铂类药物为基础的单药或联合方案及分子靶向药物逐渐被用于子宫颈癌的化疗。顺铂/卡铂+紫杉醇+贝伐珠单抗是复发性子宫颈癌的一线治疗方案,对于一线治疗无效的患者可考虑使用PD-1抑制剂派姆单抗。     

Adjuvante Therapie des Endometriumkarzinoms

FIGO I/II endometrial carcinoma has a good prognosis after hysterectomy with bilateral extirpation of the appendages and lymphadenectomy, which is particularly important in cases with unfavourable prognostic factors. Adjuvant chemotherapy with eight cycles of doxorubicin and cisplatin leads to better survival in stage III and IV compared to adjuvant, percutaneous radiotherapy. Small retrospective studies suggest an advantage for adjuvant chemotherapy in stage I/II with unfavourable prognostic factors, however, randomized studies are still required. Serous and clear cell carcinoma require a thorough, systematic surgical therapy. Retrospective work also indicates the value of adjuvant chemotherapy for this particular histological form, although this is not sufficient to provide a valid statement on a regime for adjuvant therapy.     

Chemotherapy for high-risk early-stage endometrial cancer

PURPOSE OF REVIEW: To discuss the usefulness of chemotherapy in high-risk early-stage endometrial cancer and the best chemotherapy regimen. RECENT FINDINGS: External radiation therapy has been successfully used to prevent local recurrence; however, it does not improve the overall survival and it increases the incidence of late toxicity. A recent randomized study revealed that adjuvant platinum-based combination chemotherapy might be a suitable alternative to radiotherapy for high-risk early-stage endometrial cancer. The optimal regimen is still in question because combinations of doxorubicin-cisplatin and paclitaxel-doxorubicin-cisplatin cause significant toxicity. The combination of paclitaxel-carboplatin may be better than doxorubicin-cisplatin with regard to toxicities. SUMMARY: Radiation treatment following surgery has been the standard adjuvant therapy for endometrial cancer for a long time. Radiotherapy decreases the local recurrence rates; however, a significant impact on the overall survival has not been demonstrated. The usefulness of adjuvant chemotherapy has been demonstrated by only a little evidence. Nonetheless, we are encouraged by a recent randomized study. In light of the excellent outcomes associated with early-stage endometrial cancer, it is important to conduct another large randomized trial based on standardization of high-risk criteria to evaluate the efficacy of adjuvant chemotherapy.     

术后化疗对有高危因素的早期子宫内膜癌患者预后的影响

目的 探讨术后化疗对有高危因素的早期(Ⅰ、Ⅱ期)子宫内膜癌患者预后的影响.方法 选择1994年1月-2007年6月间,北京大学第一医院妇产科收治的66例有高危因素的早期子宫内膜癌且术后均辅以化疗的患者(化疗组),40例相同期别及相同高危因素但术后未予化疗者作为对照组,Kaplan-Meier法计算两组患者的5年累积生存率,并进行比较;对有高危因素的早期子宫内膜癌患者的预后影响因素进行单因素及多因素分析.结果化疗组患者的5年累积生存率为94%,对照组为81%,化疗组明显高于对照组(P<0.05).单因素分析显示,化疗组中≥4个疗程患者的5年累积生存率为100%,<4个疗程患者的5年累积生存率为86%,两者比较,差异有统计学意义(P<0.05);而不同年龄、手术病理分期、病理类型、病理分化程度及术后有无放疗、术后化疗后是否联合放疗、有无孕激素治疗患者间比较,差异均无统计学意义(P>0.05).多因素分析显示,术后化疗是影响有高危因素的早期子宫内膜癌患者预后的独立因素(P<0.05).结论术后化疗可改善有高危因素的早期子宫内膜癌患者的预后,且疗程数应≥4个,但因例数较少,需通过前瞻性随机对照研究的进一步证实.     

Use of trastuzumab in the treatment of metastatic endometrial cancer

Systemic therapy of metastatic endometrial cancer is relatively ineffective. Response rates to chemotherapy and hormonal therapy in published studies range from 11% to 57%, but most responses are partial and of limited duration. In this case, we present a 76-year-old woman with stage IIIA endometrial adenocarcinoma who was initially treated with surgery and pelvic radiation. She developed multiple pulmonary metastases. She was treated with weekly paclitaxel chemotherapy. Immunostaining revealed that the primary endometrial cancer overexpressed HER-2/neu. Trastuzumab was added to the regimen, and a dramatic partial response was achieved. After a second pulmonary relapse following discontinuation of prior therapy, she was again successfully treated with trastuzumab in combination with paclitaxel and then docetaxel. Therefore, trastuzumab may be a useful adjuvant to taxane-based chemotherapy in some patients with metastatic endometrial cancers that overexpress HER-2/neu.     

The validity of chemotherapy in the treatment of endometrial cancer

Endometrial cancer is a heterogeneous tumour with two types which can be distinguished clinically, histologically and pathogenetically:the classical endometrioid cancer (type 1) with a good prognosis and the aggressive histological type 2 with a poor prognosis and early metastatic spread. The most active cytotoxic drugs in advanced or metastatic endometrial cancer are the anthracyclines, the platinum salts and the taxanes. In most studies, combination chemotherapy is superior to monotherapy in terms of response rates. In the last few years there is growing evidence that chemotherapy can prolong overall survival in metastatic endometrial cancer and that adjuvant chemotherapy can reduce recurrence rates in high-risk situations.     

Tamoxifen-induced endometrial cancer

OBJECTIVE: Tamoxifen-induced endometrial changes in postmenopausal women with breast carcinoma are well-known. Due to the popularity of postoperative chemotherapy for breast cancer, chemotherapy-induced early menopause in women with breast cancer on tamoxifen treatment needs more attention, because these women have higher risk for endometrial cancers than premenopausal women. SUBJECT: From May 1995 to May 1997, three premenopausal women aged 46, 43, and 39 with breast cancer were treated in our center. All patients received standard surgery for their breast cancers followed by six courses of adjuvant chemotherapy and 5-year tamoxifen treatment. All patients were regularly followed-up at the Breast Cancer Center and evaluated annually at the gynecological clinics including pelvic examination, Pap smear and transvaginal sonography. RESULTS: All patients became menopausal after six courses of chemotherapy ranging from three months to 14 months. The endometrial cancers occurred at 36 months, 28 months, and 33 months, respectively, after initial treatment for the breast cancers. Their last gynecologic examinations performed at six months, eight months and five months before the diagnosis of endometrial cancer showed nothing remarkable. Only one patient complained of vaginal spotting before diagnosis and the other two patients only complained of increasing purulent vaginal discharge. All patients received standard treatment for endometrial cancer and none of them died of their disease but one patient died of recurrent breast cancer 52 months later. CONCLUSION: Women with breast cancer on tamoxifen treatment need more attention and frequent evaluation of their reproductive organs, especially postmenopausal (either spontaneous or chemotherapy induced) women, although the American College of Obstetricians and Gynecologists (ACOG) comments that no more than annual pelvic exams with Pap smears are needed in asymptomatic women.     

Uterine papillary serous carcinoma：Its clinical and fundamental study

Uterine papillary serous carcinoma (UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and accounted for 1% ～ 10% of endometrial cancers. Theoccurencer of papillary patterns of endometrial adenocarcincma had been reportedly recognized since 1900, while until the late 1970s several authors have had described a variant of papillary endometrial cancer. UPSC is a morphologically unique variant of endometrial carcinoma that is pathologically defined by the presence of high nuclear grade, distinct papillary architechtural changes, psammoma bodies, and extensive lymph- vascular space invasion. CA125 is often mentioned a usefultumor marker either for diagnosis before starting treatment or in monitoring recurrence. The ptimal treatment of UPSC is controversial and appears to be dependent upon the stage of the disease. Primary surgery comprised of TAH/BSO and complete staging is the mainstay of treatment. The patients with recurrent UPSC in many studies were treated with various combinations of surgery, radiation therapy, and chemotherapy. The molecular basis for the general poor response of UPSC to adjuvant chemotherapy and radiotherapy is not well understood. UPSC tumors are more often aneuploid and contain overexpressed mutant p53 protein as compared to encdometrioid adenocarcinoma. Unlike patients with adenocarcinoma of the endomeutrium, women with UPSC were less likely to be obese, hypertensive, or diabetic.     

New aspects of carcinoma of the breast therapy and of gynaecological carcinoma treatment

Dose-dense chemotherapy and high dose chemotherapy have been issued in the adjuvant and primary therapy of breast cancer. Should we use GnRH analogues after chemotherapy in premenopausal women who have not become amenorrheic through chemotherapy? How important are the taxanes in the primary and adjuvant treatment of breast cancer? The optimal screening method for women at high-risk for breast cancer was addressed as one of the most important topics. Primary and recurrent ovarian cancer therapy needs to be improved further. The optimal primary therapy for endometrial cancer and cervical cancer with radiotherapy and/or chemotherapy was another addressed issue.     

Chemotherapy of endometrial cancer revisited]

The current status and future directions of chemotherapy in the management of endometrial cancer are reviewed. For patients with advanced or recurrent endometrial carcinoma the most active single drugs are doxorubicin, epirubicin, cisplatin, carboplatin, paclitaxel, ifosfamide, 5-fluorouracil and vincristine with response rates ranging from 18 to 36%. Data at the present time support the conclusion that if chemotherapy is indicated a combination of doxorubicin + cisplatin is the standard chemotherapy for patients with advanced or recurrent endometrial carcinoma and yields a response rate of 47-60%. A first trial using a combination of these drugs with paclitaxel promises an increase in response rate to 73%, but data regarding prolongation of survival are not yet available. Up to now the benefit of neither chemotherapy nor endocrine therapy could be established in the adjuvant setting.