上皮性卵巢癌的一线化疗

根据美国癌症协会2005年的癌症统计,卵巢癌仍是女性生殖道首位致死恶性肿瘤。化疗是上皮性卵巢癌的主要辅助治疗手段,新诊断上皮性卵巢癌患者在初次细胞减灭术后或分期手术后给予的辅助化疗为一线化疗(即诱导化疗),一线化疗是理想控制上皮性卵巢癌的重要环节。1上皮性卵巢癌化疗的标志性进展认识上皮性卵巢癌是一种化疗高敏感肿瘤已有50余年的历史,已发现对卵巢癌细胞敏感的细胞毒药物10余种。上皮性卵巢癌一线化疗方案的进展与新细胞毒药物的发现有关,在20世纪50～60年代,主要应用烷化剂如苯丙氨酸氮芥、苯丁酸氮芥等,以后应用非铂类为基础…     

新辅助化疗治疗晚期上皮性卵巢癌的研究进展

上皮性卵巢癌的标准治疗方案为满意的肿瘤细胞减灭术及术后辅以铂类为基础的化疗,其中满意的肿瘤细胞减灭术是治疗成功的基础。但部分患者首次手术无法达到满意的肿瘤细胞减灭术。新辅助化疗治疗晚期卵巢癌受到越来越多的关注。结合文献对新辅助化疗在晚期上皮性卵巢癌治疗中研究热点进行总结分析,认为新辅助化疗提高了满意缩瘤术的几率,然而并未改善患者的预后。临床工作中应准确评估治疗前风险,选择最有可能从新辅助化疗中获益的合适晚期上皮性卵巢癌患者,最大发挥新辅助化疗的作用。     

上皮性卵巢癌一线化疗

卵巢癌是妇科肿瘤中死亡率居首位的恶性肿瘤,上皮性卵巢癌是最常见的病理类型。化疗是绝大多数上皮性卵巢癌初次治疗中不可或缺的组成部分,具有消灭残存病灶、预防复发、提高手术切净率和作为不能手术者的主要治疗手段等多种作用。上皮性卵巢癌的一线化疗是指在初次手术后或在间隔手术前后实施的化疗,首选方案是钳类为基础的联合化疗。     

新辅助化疗在晚期卵巢上皮性癌中的应用现状

卵巢上皮性癌是死亡率最高的妇科恶性肿瘤.临床常用的治疗方案是理想的初次肿瘤细胞减灭术及术后辅以铂类+紫杉醇为基础的系统化疗.对晚期不能切除的卵巢癌,新辅助化疗能降低肿瘤负荷,提高手术切除的彻底性,是一种新的治疗策略.本文就新辅助化疗在卵巢癌治疗中的概念、目的、病例选择标准、术前选择新辅助化疗的评估方法、化疗方案、疗程、给药途径,疗效评价及临床价值等进行综述.     

复发上皮性卵巢癌治疗中值得关注的几个问题

复发上皮性卵巢癌的治疗一直是妇科肿瘤领域关注和探讨的热点。根据患者对铂类化疗敏感性的不同,将复发上皮性卵巢癌分为铂敏感和铂耐药两大类。本文基于临床研究及指南推荐,分别针对复发上皮性卵巢癌治疗中需要重点关注的手术、化疗、去化疗,以及如何规范地应用维持治疗问题进行阐述,探讨不同类型复发患者的治疗策略。     

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,文章指出了临床实践中上皮性卵巢癌化疗不规范的问题,强调应重视化疗的规范性,以助于提高我国晚期上皮性卵巢癌患者的生存率。     

上皮性卵巢癌的免疫治疗现状与问题

卵巢癌是病死率最高的妇科恶性肿瘤,全球每年约20万新发病例,超过15万的死亡病例。上皮性卵巢癌是最常见的病理类型,主要治疗方式为肿瘤细胞减灭术和术后化疗。然而,大部分上皮性卵巢癌在诊断时已为晚期,并且70%-80%患者复发,其5年生存率不足50%。因此,上皮性卵巢癌患者,尤其是化疗耐药的患者,亟需新的治疗手段。     

卵巢癌肉瘤的研究现状与进展

卵巢癌肉瘤是一种具有高度侵袭性的恶性肿瘤,组织中同时含有癌和肉瘤两种成分,发病率低,多见于绝经后妇女。该病早期诊断困难,就诊时多属晚期。与上皮性卵巢癌相比,其恶性程度更高,对化疗的敏感度更低,预后更差。由于该病比较罕见,难以进行大规模前瞻性的临床研究,使建立系统的治疗指南面临巨大挑战。目前该病治疗多是基于回顾性研究或上皮性卵巢癌的治疗经验,肿瘤细胞减灭术是其主要的手术治疗方式,关于术后辅助化疗,国际上尚无规范的化疗方案,多数研究支持以铂类为基础的联合化疗,放疗的作用尚不确定,靶向治疗仍在进一步研究中。     

p73表达与上皮性卵巢癌化疗敏感性的关系

目的:探讨抑癌基因p73在卵巢癌的表达及与上皮性卵巢癌化疗敏感性的关系。方法:应用免疫组化法检测50例上皮性卵巢癌p73的表达,在手术的基础上,予以6个疗程以铂类为主的联合化疗,分析其表达与上皮性卵巢癌化疗敏感性的相关性。结果:p73表达与上皮性卵巢癌的化疗敏感性有关,与上皮性卵巢癌患者的年龄和病理类型无关。p73在化疗敏感型的14例上皮性卵巢癌中表达率为88.89%,在化疗不敏感型的36例上皮性卵巢癌中表达率为35.48%,差异有显著性(P=0.000)。p73在不同病理分期和组织学分级的上皮性卵巢癌组织中表达率差异有显著性,在组织分化差及晚期病灶中表达率明显升高(P=0.004,P=0.005)。结论:卵巢癌p73表达变化可能与上皮性卵巢癌的化疗敏感性有关。     

卵巢上皮性癌脑转移

卵巢上皮性癌脑转移是卵巢癌少见的并发症.脑转移发生率增高主要与目前正规、有效的化疗使肿瘤患者生存期延长有关.其诊断依据病史、症状和辅助检查,比较容易.治疗方法主要有外科手术、立体定向放疗、全脑放疗、化疗及其他治疗方法综合应用.对近年来卵巢上皮性癌脑转移的发生率、发病机制、诊断、治疗措施及预后情况综述如下.     

Intra-arterial infusion chemotherapy with cisplatin in the management of advanced uterine cervical cancer]

To improve the cure rate for locally advanced cervical cancer, intra-arterial infusion chemotherapy with cisplatin (I-A chemotherapy) was performed before starting radiation therapy. Twenty-five patients, having a large central tumor (over 5 cm in antero-posterior diameter by CT scan), were treated by I-A chemotherapy. The catheter was inserted selectively into the uterine artery. The dose of cisplatin was 120 mg/m2. After the chemotherapy, all the patients were treated by radiation therapy. Eighteen of 25 patients treated with I-A chemotherapy were evaluable. Seven patients (38.8%) experienced partial tumor regression (greater than 50% reduction in the measured diameter). The survival rate (Kaplan-Meier Method) for combined therapy with I-A chemotherapy and radiotherapy was significantly higher than that for 23 patients treated by conventional radiation therapy alone. The toxicity of I-A chemotherapy was similar to that of systemic administration. There were three catheter complications. Intra-arterial chemotherapy with cisplatin followed by radiation therapy is effective for advanced uterine cervical cancer.     

宫颈癌新辅助化疗临床研究现状

新辅助化疗是指在局部治疗（手术或放疗）前给予的全身化疗。近二十余年来国内外学者对宫颈癌新辅助化疗联合手术或放疗 的治疗模式进行了一些探索,取得一定经验。但新辅助化疗在宫颈癌治疗中的地位仍未明确,且对其化疗方案选择目前无统一认识。对新辅助化 疗在宫颈癌治疗方面的最新进展、多种新辅助化疗方案应用于宫颈癌的疗效及其发展趋势做综述。     

宫颈癌新辅助化疗临床研究现状

新辅助化疗是指在局部治疗（手术或放疗）前给予的全身化疗。近二十余年来国内外学者对宫颈癌新辅助化疗联合手术或放疗的治疗模式进行了一些探索,取得一定经验。但新辅助化疗在宫颈癌治疗中的地位仍未明确,且对其化疗方案选择目前无统一认识。对新辅助化疗在宫颈癌治疗方面的最新进展、多种新辅助化疗方案应用于宫颈癌的疗效及其发展趋势做综述。     

Complete response to radiation therapy in a patient with chemotherapy-resistant ovarian clear cell adenocarcinoma

Recurrent ovarian cancer after front-line chemotherapy is incurable. In most institutions, chemotherapy is continued as salvage therapy after primary chemotherapy failure and despite the fact that long-term survival and complete responses are infrequent. Radiation therapy for patients with recurrent ovarian cancer has often been done with palliative intent. A patient with ovarian clear cell adenocarcinoma received irradiation with palliative intent to the whole pelvis after chemotherapy (paclitaxel, carboplatin, and irinotecan) produced no effect. Although she developed a rectovaginal fistula due to cancer invasion during radiation therapy. One year and half after the therapy, she is still alive with no evidence of disease. In an effort to maximize sa lvage potential and quality of life while minimizing toxicity, selected patients with ovarian cancer should be treated with radiation therapy directed to residual or recurrent sites. Received: 20 September 2001 / Accepted: 25 September 2001 Correspondence to N. Takai     

Adjuvant chemotherapy in primary carcinoma of the breast

The 2003 St. Gallen consensus on primary therapy of early breast cancer confirmed the importance of adjuvant chemotherapy. In endocrine non-responsive tumors, chemotherapy is adjuvant treatment of choice, independent of patient age or lymph node status. In endocrine-responsive disease, chemotherapy plays an important role next to endocrine treatment. The questions, which patients need combined chemo-endocrine therapy, and for whom endocrine therapy alone is sufficient, are still unsolved. Anthracyclines are standard adjuvant chemotherapy; superiority over CMF has only been shown for anthracyclin-containing polychemotherapy with at least 3 substances. Recent published evidence suggest that adding taxanes to anthracyclin regimens may benefit patient survival and that taxanes are a valid therapeutic option in node-positive, hormone receptor negative breast cancer. The optimal use of taxanes in different risk collectives is currently being investigated in clinical trials. Generally, adjuvant chemotherapy should be administered before radiotherapy, and endocrine therapy should be given sequentially. In view of the international St. Gallen panel, the final publication may only represent a minimal consensus. Individual countries are requested to adapt these recommendations to national conditions. In Germany, up-to-date evidence-based therapy recommendations have just been issued by the AGO "breast" expert panel. Interdisciplinary S3 breast cancer guidelines are currently being finalized.     

Diagnosis and therapy of uterine sarcoma

Radical surgery in stage I and II uterine sarcoma removing all tumor manifestations is the only curative therapy option for early stage disease. Larger tumors (> 4 cm) and the presence of lymph node metastasis correlate with a high local recurrence rate. For these tumors adjuvant radiation and/or adjuvant chemotherapy may be recommended after surgical therapy. Adjuvant therapy however, should preferably be considered for uterine stromal sarcomas and mixed mesodermal tumors. The toxicity of radiation and/or chemotherapy is greater than any possible benefit for patients with leiomysarcomas as these tumors rarely respond to radiation or chemotherapy. For advanced (> stage I and II) and recurrent disease, curative therapy options are not available and palliative therapy for these patients has to take into consideration the negative side effects and weigh up quality of life against an often very limited possible benefit of such therapy.     

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.     

Intraperitoneal hyperthermic chemotherapy in ovarian cancer

We investigated the effect of intraperitoneal hyperthermic perfusion chemotherapy as consolidation therapy in stage IIIB-IIIC ovarian cancer, following cytoreductive surgery and systemic chemotherapy (cisplatin-cyclophosphamide--six cycles). Disease-free survival, overall survival, and side effects were compared with a control group of patients who refused a second-look surgery and intraperitoneal chemotherapy. In a multicenter prospective trial, 29 patients with complete or optimal cytoreductive surgery and systemic treatment were included in the consolidation group and received intraperitoneal hyperthermic perfusion chemotherapy. Patients were recruited between January 1991 and December 1997. The intraperitoneal hyperthermic perfusion was performed with open-abdomen technique, using physiologic solution containing cisplatin 100 mg/m2, for 60 min in hyperthermic phase (41-43 degrees C). Intraperitoneal hyperthermic perfusion chemotherapy was locally and systemically well tolerated. The consolidation therapy group showed a better 5-year survival rate and lower recurrent disease rate, but differences were not statistically significant. Our results suggest that intraperitoneal hyperthermic perfusion chemotherapy is a feasible, well-tolerated, and promising alternative as consolidation therapy in ovarian cancer.     

Role of surgical therapy and radiotherapy in gestational trophoblastic disease

Surgical procedures and radiotherapy continue to play a significant role in the management of gestational trophoblastic disease (GTD) despite continuing advances in chemotherapy. Suction curettage and hysterectomy are preferred techniques for evacuation of hydatidiform mole. Although primary chemotherapy alone is usually successful in women with nonmetastatic or good-prognosis metastatic GTD, hysterectomy is useful in selected patients to decrease the amount of chemotherapy required to produce remission or as salvage therapy in patients who have failed primary chemotherapy. Even among patients with poor-prognosis metastatic GTD, such adjunctive surgical procedures as hysterectomy, thoracotomy and craniotomy may be useful. Whole brain and liver irradiation is employed as adjuvant therapy to reduce hemorrhagic complications of brain and liver metastases.     

卵巢癌患者生活质量的研究

尽管卵巢癌的诊断和治疗技术不断发展，其病死率仍居妇科恶性肿瘤首位。在疾病每一阶段（手术、化疗、随访、复发及其后的治疗、肠梗阻以及临终阶段）生活质量始终是应考虑的最重要因素之一。近年来，大量研究对卵巢癌患者的生活质量进行评估。不同的化疗药物、化疗途径以及化疗时机对卵巢癌患者的生活质量有不同的影响。选择不同的治疗方案以及治疗效果的不同对患者生活质量的影响也有差别。治疗后出现的并发症及晚期卵巢癌患者的症状都会影响患者的生活质量。其他如情感问题，包括心理情绪问题、婚姻、家庭社会支持等也会导致生活质量的改变。