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。     

Evaluation of the effectiveness of second-line intraperitoneal chemotherapy for patients with ovarian cancer

OBJECTIVES: From a theoretical viewpoint, intraperitoneal therapy in patients with ovarian cancer, a malignancy, which remains mainly confined to the peritoneal cavity is logical. Intraperitoneal catheters have moved to the forefront as a delivery system in cancer treatment. DESIGN: The authors sought to evaluate effects of intraperitoneal chemotherapy (IPC) as a second line therapy for ovarian cancer patients. MATERIAL AND METHODS: From January 1996 to January 2002, 92 patients with recurrent or persistent cancer, after surgery, and first line chemotherapy, were treated with intraperitoneal chemotherapy as a second-line treatment. Only 74 were included in the study, due to incomplete of therapy (6 patients), spontaneous fold-out of catheter (3 patients), five patients were treated because of some other kind of carcinomas, three patients passed away during therapy because of independent reasons, and weren't be verified and a patient who had wrong pathological diagnosis in SLL. RESULTS: The three year survival in the whole group reached 58.62% for patients who responded to the first line chemotherapy, or when the debulking surgery was completed, which was a significant improvement in survival. There was a significant improvement in survival for patients with residual tumor < 5 mm compared with the whole group, and especially with these, whose residual tumors were greater then 5 mm. CONCLUSIONS: 1. Survival was increased for patients who had a positive response to the first line intravenous chemotherapy, or had complete a debulking surgery 2. The response for IPC depends on the size of residual disease. 3. Intraperitoneal chemotherapy improves survival 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 doxorubicin in combination with systemic cisplatinum and cyclophosphamide in the treatment of stage III ovarian cancer

Recent concepts and technical development have led to the successful application of the principles of intraperitoneal chemotherapy in the management of advanced epithelial ovarian cancer. In a pilot study we treated five patients with Stage III ovarian cancer after maximal cytoreductive effort (residual tumor less than or equal to 2 cm) with combination chemotherapy consisting of intraperitoneal doxorubicin and intravenous cisplatinum and cyclophosphamide. Although intraperitoneal doxorubicin demonstrates a pharmacologic advantage over the intravenous administration of this drug, its use is limited by severe abdominal pain requiring narcotic analgesics. Chemical peritonitis and extensive peritoneal adhesions are frequent complications. The role of combination intraperitoneal and systemic chemotherapy in ovarian cancer warrants further study.     

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。     

Vaginal evisceration during intraperitoneal chemotherapy for advanced ovarian cancer

BACKGROUND: Recent studies have established that intraperitoneal chemotherapy is associated with improved outcomes compared with intravenous treatment in patients with advanced, optimally cytoreduced ovarian cancer, but at the expense of increased toxicity. We present a case of vaginal evisceration during intraperitoneal chemotherapy for advanced ovarian cancer. CASE: Following an optimal cytoreduction including total hysterectomy for advanced ovarian cancer, a 63-year-old woman underwent intraperitoneal chemotherapy. On pelvic examination prior to her second cycle of chemotherapy, she was found to have vaginal evisceration of small bowel. CONCLUSION: Intraperitoneal chemotherapy imparts an improved survival, but at the expense of increased toxicity. It is possible that the increased abdominal pressure during intraperitoneal chemotherapy contributes to the risk for vaginal evisceration. In patients planning on undergoing intraperitoneal chemotherapy, supracervical hysterectomy should be considered in appropriate candidates.     

Aggressive chemosurgical debulking in patients with advanced ovarian cancer

From July 1986 to June 1989, 43 evaluable patients with advanced ovarian cancer were treated on protocol with initial cytoreductive surgery, two courses of high-intensity intravenous Cytoxan (1000 mg/m2) and cisplatin (120-200 mg/m2) chemotherapy, and repeat debulking laparotomy in an effort to maximize response to a subsequent four cycles of intraperitoneal platinum-based chemotherapy. Two patients were stage IIIA, 2 stage IIIB, 28 stage IIIC, and 11 stage IV. Five tumors were grade 1, 9 grade 2, and 29 grade 3. Thirty-eight (88%) patients had bulky tumor (5-25 cm) found at first laparotomy; 25 of these had greater than 1-cm residual after initial debulking. Following two cycles of intensive intravenous chemotherapy 18 of these 25 had greater than 1-cm disease found at second laparotomy; 12 of 18 underwent secondary cytoreduction to less than 1 cm. Thus, 30 of these 38 (79%) patients entered the intraperitoneal phase of the protocol with less than 1-cm disease. Four patients had 2- to 5-cm tumor at initial laparotomy; two of four were debulked to less than 1-cm residual. All four were found to have less than 1-cm disease at second laparotomy. This combination regimen was well tolerated. There was one treatment-related death. In sum, 42 of 43 patients had tumor greater than 2 cm at staging laparotomy and 38 (88%) had large, bulky disease (5-25 cm); 34 of 43 (79%) entered the intraperitoneal phase of the protocol with optimal (less than 1-cm) disease. Aggressive chemosurgical cytoreduction in patients with bulky advanced ovarian cancer can leave a large proportion of patients with minimal residual disease and maximize their chances of responding to subsequent intraperitoneal chemotherapy.     

Evaluation of risk factors after intraperitoneal chemotherapy in patients with ovarian cancer]

DESIGN: The authors sought to evaluate risk factors of patients with ovarian cancer treated with intraperitoneal cisplatin based chemotherapy (IPC). MATERIAL AND METHODS: From January 1996 to December 1998, 24 patients with recurrent or persistent ovarian cancer were treated. We divide them in two groups first beneath 65 year old (19 patients), second above 65 year (5 patients), and in three groups with residual microscopic diseases, residual below 0.5 cm, and between 0.5 and 2 cm in the time of the beginning of treatment with IPC. We also estimate stage (FIGO) as a risk factor. RESULTS: In the first group the study showed (CRP) among 9 patients (SD) among 2 patients PD in among patients. In the second group CRP were observed among 2 patients PD among 2 patients, and SD 1 patient. CONCLUSION: IPC is the valuable method of second line chemotherapy for ovarian cancer. Age is not a risk factor in IPC. IPC prolongs survival in ovarian cancer patients, progression free survival, and gives only slightly adverse effects.     

腹腔灌注与静脉化疗治疗晚期卵巢癌的疗效对比研究

目的：比较单纯静脉给药化疗与腹腔灌注化疗2种给药途径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62例晚期上皮性卵巢癌患者,将患者随机分为静脉滴注组和腹腔灌注组。静脉滴注组方案：紫杉醇135 mg/m2静脉滴注,24 h 后顺铂75 mg/m2静脉滴注;腹腔灌注组方案：紫杉醇135 mg/m2静脉滴注,24 h 后顺铂100 mg/m2腹腔灌注,第8天给予紫杉醇60 mg/m2腹腔灌注。所有患者进行随访,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：腹腔灌注组肿瘤缓解率较静脉滴注组有增高趋势,但差异无统计学意义（P＞0.05）;腹腔灌注组的疾病无进展生存期（progression-free survival,PFS）和2年生存率均显著高于静脉滴注组,差异有统计学意义（P＜0.01）。腹腔灌注组的不良反应发生率高于静脉滴注组,2组贫血、肝功能损害及神经毒性发生率差异有统计学意义（P＜0.05）。结论：腹腔灌注化疗可有效提高晚期上皮性卵巢癌患者的PFS和2年生存率,改善患者预后。     

晚期卵巢上皮性癌化学药物治疗的意义及远期疗效的影响因素

目的：探讨晚期卵巢上皮性癌化学药物治疗（化疗）的意义及远期疗效的影响因素,方法：自1986年1月至1997年12月我院收治晚期卵巢上皮性癌患者348例,根据残留癌直径的大小分为切净组（残留癌直径≤1cm)和未切净组（残留癌直径＞1cm),Log-rank检验分析两组患者的生存率差异,Logistic回归模型分析影响远期分别为46个月和36个月,差异有显著性（χ^2=7.39,P=0.0065);未切净组患者术后静脉化疗＞6个疗程与≤6个疗程的中位生存期分别是22个月和11个月,差异有显著性（χ^2=4.31,P=0.0380）,多因素分析结果显示,切净组患者的预后与术后腹腔化疗有关;而未切净组患者的预后则与术后静脉化疗,术前化疗（P＜0．01）,和病理分级（P＜0．05）有关,晚期卵巢上皮性癌患者的远期疗效主要与残留癌直径（P＜0．01）,术后腹腔化疗（P＜0．05）,病理分级（P＜0．05）有关,结论：术后给予＞6个疗程的静脉化疗改善了晚期卵巢上皮性癌未切净组患者的近期疗效,但远期疗效无明显改善,腹腔化疗与晚期卵巢上皮性癌患者的远期疗效有关,邮切净组患者的生存期。     

Long term survival of patients with advanced ovarian cancer treated with intraperitoneal radioimmunotherapy

Abstract. Epenetos AA, Hird V, Lambert H, Mason P, Coulter C. Long term survival of patients with advanced ovarian cancer treated with intraperitoneal radioimmunotherapy.
Purpose: To determine the long term survival of patients with advanced ovarian cancer treated with radioimmunotherapy following cytoreductive surgery and platinum based chemotherapy.
Patients and Methods: Eligibility criteria included patients with histological evidence of ovarian cancer stages IC-IV following completion of conventional platinum containing chemotherapy. Of 52 patients entered into the study, 31 had residual disease following standard chemotherapy and 21 patients had achieved complete remission. Treatment consisted of one intraperitoneal administration of 25 mg of monoclonal antibody HMFG1 labelled with 18 mCi/m² of ⁹⁰Y. Survival was the primary end-point.
Results: In the group of 21 patients who had achieved complete remission following surgery, conventional chemotherapy and intraperitoneal radioimmunotherapy, the median survival has not been reached with a maximum follow-up of 12 years. Survival at greater than 10 years is 78%.
Conclusion: This study suggests that a substantial proportion of patients who achieve complete remission with conventional therapy can achieve a long-term survival benefit when treated with intraperitoneal radioimmunotherapy using HMFG1 labelled with ⁹⁰Y.     

Quality of life in women treated with neoadjuvant chemotherapy for advanced ovarian cancer: a prospective longitudinal study

OBJECTIVE: The purpose was to examine the outcomes of patients with advanced ovarian cancer treated with neoadjuvant chemotherapy, with a special emphasis on the patients' quality of life (QOL). METHODS: Seventeen patients with advanced ovarian cancer were treated with neoadjuvant chemotherapy based on the extent of disease on computer tomography. All patients received combined platinum/paclitaxel chemotherapy. Debulking surgery was performed after three cycles or six cycles of chemotherapy, depending on the response to the chemotherapy. Patients' QOL was studied over time using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and was then compared with that of patients treated with conventional treatment in the previous cohort. RESULTS: The response rate to chemotherapy assessed at three cycles was 82.4%. The rate of optimum debulking to residual disease less than 2 cm after chemotherapy was 76.9%, and 38.5% had no gross residual disease after surgery. The median overall survival was 22.9 months. The median disease-free interval was 13.3 months. The overall QOL improved after chemotherapy and this continued to improve up to 12 months. The other functional scales also showed improvements over time, apart from the initial transient deterioration in the role functioning and cognitive functioning at 3 months after chemotherapy. Patients treated with neoadjuvant chemotherapy seem to have better but statistically insignificant difference in QOL parameters than patients treated conventionally. CONCLUSION: Neoadjuvant chemotherapy is an alternative treatment for patients with advanced ovarian cancer in whom the chance of optimal cytoreduction is low. The patients' overall quality of life and functional status improve after neoadjuvant chemotherapy.     

Clinical aspects of intraperitoneal chemotherapy in patients with ovarian carcinoma

Ten women with primary ovarian carcinoma in clinical progression grade III degree according to FIGO received intraperitoneal chemotherapy. They all had surgical treatment and 9 of them received after operation intravenous cytostatics PAC or PC. Cisplatin 100-220 mg/m2 was given intraperitoneally through a Tenckhoff catheter for long-term dialysis. Before beginning of intraperitoneal chemotherapy in 6 cases the malignant lesions were under 2 cm in diameter, and in 4 cases the size of these lesions was exceeding 2 cm with far advanced disease. In patients with malignant lesions under 2 cm CR was obtained in 4 cases, SD in 1 case and PR in 1 case. In the group with malignant lesions exceeding 2 cm the results of intraperitoneal treatment were: SD in 2 cases and PD in 2 cases. Intraperitoneal chemotherapy is an effective method in ovarian carcinoma when intravenous chemotherapy is ineffective. This is another method which provides a chance of prolongation of the life of the patients.     

ACOG Committee Opinion No. 396. Intraperitoneal chemotherapy for ovarian cancer

Postoperative intravenous (IV) chemotherapy for advanced stage ovarian cancer has been the standard treatment . Recent studies have found significant survival advantages with the use of adjuvant intraperitoneal (IP) chemotherapy. Combination IV/IP chemotherapy may be an option for well counseled, carefully selected patients with optimally debulked stage III ovarian cancer. However, IV/IP treatment also has increased rates of pain, fatigue, and hematologic, gastrointestinal , metabolic, and neurologic toxicities. Given the balance of efficacy, quality of life, and toxicity, the decision to use IP chemotherapy must be individualized.     

盐酸拓扑替康腹腔注射对大鼠腹腔器官及外周血白细胞的影响

目的 :探索拓扑替康腹腔化疗的安全性和可行性。方法 :以健康SD雌性大鼠为研究对象 ,观察拓扑替康腹腔化疗对大鼠腹腔内器官和外周血白细胞的影响。结果 :在剂量与静脉化疗总量相同和加大一倍时 ,拓扑替康腹腔化疗除引起与对照组相同的子宫炎症反应外 ,大网膜产生炎症反应 ;对卵巢和胰腺等则均无明显影响 ;当应用 4倍剂量时 ,造成胰腺实质间质部炎症反应。对外周血白细胞计数的影响与剂量有关 ,虽然各剂量腹腔化疗后第 3天 ,外周血白细胞计数都有下降 ,但仅在相当于静脉化疗剂量 2倍时 ,下降有统计学意义 ,剂量加大至 4倍时 ,虽然无统计学意义 ,但此实验组的白细胞计数在化疗后 5天无明显回升 ,直至化疗后 8天才恢复。其他实验组白细胞计数在化疗后 5天已回升至化疗前水平。结论 :拓扑替康腹腔化疗对大鼠外周血白细胞计数无严重影响 ,在适当剂量下对腹腔各正常器官也无明显刺激 ,对其一般情况等无明显作用。所以 ,在适当剂量下拓扑替康腹腔化疗是安全的 ,它为治疗卵巢肿瘤 ,特别是晚期、复发及耐药的卵巢肿瘤提供了新的途径。     

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.     

Neoadjuvant chemotherapy or primary surgery in advanced epithelial ovarian carcinoma

Abstract. Kayikçiōlu F, Köse MF, Boran N, Çalişkan E, Tulunay G. Neoadjuvant chemotherapy or primary surgery in advanced epithelial ovarian carcinoma.
Neoadjuvant chemotherapy has been proposed as an alternative approach to conventional surgery as initial management of bulky ovarian cancer, with the goal of performing adequate debulking in the interval surgery. Two hundred five consecutive patients with advanced ovarian cancer were divided into two groups. Neoadjuvant chemotherapy followed by interval surgery was performed in 45 of 205 patients. The remaining 158 patients received primary surgery plus adjuvant chemotherapy. Optimal cytoreductive surgery rates were significantly higher in the neoadjuvant CT group ( P< 0.001). In multivariate analysis, only residual tumor diameter and appendix involvement were found to affect total survival significantly in both groups. Five-year survival and median survival were not statistically different when all patients treated conventionally were compared with all patients treated with neoadjuvant chemotherapy. Primary chemotherapy followed by interval debulking surgery in a selected group of patients does not appear to worsen prognosis, but it permits less aggressive surgery and improves patients' quality of life.     

Diagnosis and management of epithelial ovarian cancer

Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States. Although there has been a statistically significant improvement in 5-year survival, in 2005 more than 16,000 women were expected to die of this disease. To date, there is no reliable method to screen for ovarian cancer; therefore, the majority of cases are diagnosed with advanced disease. For early ovarian cancer, appropriate surgical staging and adjuvant chemotherapy for selected cases will result in survival rates of 90-95%. For advanced ovarian cancer, survival depends primarily on the success of the initial surgical procedure. Patients with complete cytoreduction to microscopic disease are often cured with adjuvant chemotherapy. There is growing evidence that these patients with microscopic residual disease are excellent candidates for intraperitoneal chemotherapy, and this mode of chemotherapy delivery may be their best opportunity for cure. Patients with optimal cytoreduction also may benefit from intraperitoneal chemotherapy, but cure is less likely. For patients with suboptimal cytoreduction, intravenous chemotherapy with a combination of carboplatin and paclitaxel is the current standard therapy. Most of these patients will experience recurrence of the cancer, with small chance of cure. Salvage chemotherapy is important in ovarian cancer because many patients respond to several salvage regimens. Because of the high response rate of ovarian cancer, even after relapse, it is probably better to consider 10-year survival as the ideal end point. Finally, new biologic agents, in combination with traditional surgery and chemotherapy, may result in further improvement in survival for patients with ovarian cancer.     

晚期卵巢上皮性癌不同化疗途径临床对比研究

目的 探讨晚期卵巢上皮性癌(卵巢癌)腹腔与静脉两种途径化疗的利弊关系.方法 回顾性分析1998年1月-2006年1月经湖南省肿瘤医院收治的226例晚期卵巢癌患者的临床资料,患者均行肿瘤细胞减灭术(包括满意的和不满意的肿瘤细胞减灭术),且术后接受了6～8个疗程的规范性化疗,化疗方案为紫杉醇+顺铂或卡铂(TP)、顺铂+环磷酰胺(PC)、顺铂+环磷酰胺+多柔比星(PAC)方案.将患者随机分为腹腔化疗组(IPC组,120例)和静脉化疗组(IVC组,106例),对两组患者的疗效、复发及生存情况、化疗所致的毒副反应及并发症进行比较.结果 (1)疗效:第一阶段(3个疗程后)评定,IPC、IVC组的有效率分别为75.8%、52.8%,两组比较,差异有统计学意义(P＜0.01);第二阶段(总疗程结束后)评定,IPC、IVC组的有效率分别为93.9%、87.7%,两组比较,差异无统计学意义(P＞0.05).(2)复发情况:IPC、IVC组行满意的肿瘤细胞减灭术后患者的复发率分别为47.0%、59.4%,两组比较,差异无统计学意义(P＞0.05);行不满意的肿瘤细胞减灭术后患者的复发率分别为84.8%、86.2%,两组比较,差异无统计学意义(P＞0.05).IPC、IVC组复发时间分别为24、18个月,IPC组较IVC组延长了6个月,两组比较,差异有统计学意义(P=0.001).(3)生存情况:IPC、IVC组总的生存时间分别为32和30个月,两组比较,差异无统计学意义(P=0.188).(4)化疗毒副反应及并发症:IVC、IPC组化学性静脉炎的发生率分别为34.0%、10.8%,两组比较,差异无统计学意义(P＜0.01);化疗所致的严重消化道反应分别为33.8%、25.8%,两组比较,差异无统计学意义(P=0.236);骨髓抑制率分别为24.5%、25.0%,两组比较,差异无统计学意义(P=0.906);肠粘连发生率分别为5.0%、1.8%,两组比较,差异无统计学意义(P=0.206).结论 IPC比IVC可延长患者复发时间,但对总的生存时间无明显影响,IPC可降低化学性静脉炎的发生率.IPC有一定局限性,不能取代IVC,但两者配合使用可互补疗效,减少并发症的发生.     

Long-term follow-up of patients with advanced ovarian cancers treated with intermittent administration of combination chemotherapy with cisplatin, doxorubicin and cyclophosphamide

Despite high primary response rates with cisplatin-based combination chemotherapy, the overall survival rate for advanced ovarian cancers remains dismal. We designed a new systematic treatment approach with a combination chemotherapy consisting of cisplatin, doxorubicin and cyclophosphamide (cyclic PAC chemotherapy), with the aim of improving survival rates with minimal disturbance of quality of life. Cyclic PAC chemotherapy is a three-step chemotherapy with three courses of the PAC regimen in each step. A total of nine courses with a 3-month drug-free period between each step were administered over a 15-month period to patients with clinical stage IC-IV ovarian cancer who had undergone cytoreductive surgery. Forty-eight patients with stage IC-IV disease (34 patients with stage III and IV disease) were treated with cyclic PAC chemotherapy. Thirty-four patients with stage IC-IV disease (23 patients with stage III and IV disease) were treated by a brief course of PAC chemotherapy. Long-term survival and toxicity were evaluated for both treatment groups. Cyclic PAC chemotherapy improved the overall outcome of patients (66.6% 3-year and 56.5% 5-year survival rates) compared to brief PAC (41.2% 3-year and 23.5% 5-year survival rates) ( P < 0.01). The outcome of patients with stage III-IV ovarian cancer of the cyclic PAC group (52.6% 3-year and 37.2% 5-year survival rates) was also superior to that of the brief PAC group (21.7% 3-year and 8.7% 5-year survival rates). Generally, the treatment was well tolerated. The toxicity was similar in both groups, although myelosuppresion and neurotoxicity were rather prominent in the cyclic PAC group. Cyclic PAC chemotherapy may lead to improved survival in advanced ovarian cancer, and merits further investigation in a randomized study.