Carey Mark S, Gawlik Christine, Fung-Kee-Fung Michael, Chambers Alexandra, Oliver Tom
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Gynecol Oncol. 2006 Apr;101(1):158-67. doi: 10.1016/j.ygyno.2005.11.019. Epub 2006 Jan 24.
To evaluate the chemotherapeutic options for women with advanced or recurrent endometrial cancer.
The MEDLINE, CANCERLIT and the Cochrane Library databases were searched from 1984 to March 2005 for randomized controlled trials (RCTs) comparing chemotherapy regimens in patients with advanced or recurrent endometrial cancer. Studies were included only if patients had measurable or evaluable disease, and/or response rates were reported.
Seventeen RCTs compared regimens involving chemotherapy and/or hormonal therapies. Three chemotherapy trials demonstrated a statistically significant difference in response rates between treatment arms, but only one of these trials showed a modest survival advantage. The addition of cisplatin to doxorubicin in two RCTs significantly improved response rates (1.7- to 2.5-fold higher) but did not impact on survival. In two other RCTs using cisplatin and doxorubicin as standard therapy, the addition of paclitaxel improved response rates (57% versus 34%) and median survival (15.3 versus 12.3 months) when combined with cisplatin and doxorubicin but not when combined with doxorubicin only. Toxicity was increased with the three-drug combination. Quality of life was assessed in one trial, which is currently only in abstract form. Medroxyprogesterone acetate (200 mg/day) was effective in one RCT, particularly in patients with well-differentiated, receptor-positive tumors.
Combination chemotherapy with doxorubicin and cisplatin results in higher response rates than doxorubicin alone. The addition of paclitaxel to either of these regimens resulted in a small survival advantage in one trial using all three drugs. In light of the limited survival advantage associated with this regimen, the use of less toxic combinations of taxanes with carboplatin requires further study. Medroxyprogesterone acetate is useful in selected patients.
评估晚期或复发性子宫内膜癌女性患者的化疗方案。
检索1984年至2005年3月的MEDLINE、CANCERLIT和Cochrane图书馆数据库，查找比较晚期或复发性子宫内膜癌患者化疗方案的随机对照试验（RCT）。仅纳入患者患有可测量或可评估疾病和/或报告了缓解率的研究。
17项RCT比较了涉及化疗和/或激素疗法的方案。三项化疗试验显示治疗组之间的缓解率有统计学显著差异，但其中只有一项试验显示出适度的生存优势。在两项RCT中，顺铂与阿霉素联合使用显著提高了缓解率（高1.7至2.5倍），但对生存无影响。在另外两项使用顺铂和阿霉素作为标准疗法的RCT中，与顺铂和阿霉素联合使用时，紫杉醇的加入提高了缓解率（57%对34%）和中位生存期（15.3个月对12.3个月），但仅与阿霉素联合使用时未提高。三联药物组合增加了毒性。在一项目前仅以摘要形式存在的试验中评估了生活质量。醋酸甲羟孕酮（200mg/天）在一项RCT中有效，特别是在高分化、受体阳性肿瘤患者中。
阿霉素和顺铂联合化疗的缓解率高于单独使用阿霉素。在一项使用所有三种药物的试验中，在这些方案中加入紫杉醇可带来小的生存优势。鉴于该方案相关的生存优势有限，使用毒性较小的紫杉烷与卡铂组合需要进一步研究。醋酸甲羟孕酮对选定患者有用。
