Markman Maurie
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Semin Oncol. 2006 Apr;33(2 Suppl 6):S33-8. doi: 10.1053/j.seminoncol.2006.03.013.
Despite substantial documented progress in the chemotherapeutic management of women with gynecologic malignancies, a number of highly clinically relevant issues remain unresolved. In ovarian cancer, questions asked by practicing oncologists, patients, and their families include the role of maintenance chemotherapy in routine management of the disease, determining which patients with early stage disease do not require cytotoxic therapy, defining the most appropriate management paradigm for both recurrent and resistant cancer, determining which taxane to combine with carboplatin in the first-line regimen, and developing an optimal intraperitoneal primary chemotherapy regimen for small-volume residual advanced disease. In endometrial cancer, important issues include defining first-line chemotherapy for metastatic or recurrent disease and mixed mesodermal endometrial cancer, and determining whether there is a role for adjuvant cytotoxic chemotherapy in the setting of high-risk early stage cancer. Finally, in cervical cancer, there is a critical need to determine the most appropriate treatment strategy for metastatic cancer, as well as to find an effective second-line treatment option for platinum-resistant disease. It is reasonable to anticipate that future clinical trials will answer these and other unresolved issues, just as past well-designed studies have resulted in major improvements in both the survival and quality of life of women with this group of malignancies.
尽管在妇科恶性肿瘤患者的化疗管理方面已有大量文献记载的进展，但仍有一些高度相关的临床问题尚未得到解决。在卵巢癌方面，执业肿瘤学家、患者及其家属提出的问题包括维持化疗在该疾病常规管理中的作用、确定哪些早期疾病患者不需要细胞毒性治疗、为复发性和耐药性癌症确定最合适的管理模式、确定在一线治疗方案中哪种紫杉烷与卡铂联合使用，以及为少量残留的晚期疾病制定最佳的腹腔内初始化疗方案。在子宫内膜癌方面，重要问题包括确定转移性或复发性疾病以及混合性中胚叶子宫内膜癌的一线化疗方案，以及确定在高危早期癌症情况下辅助细胞毒性化疗是否有作用。最后，在宫颈癌方面，迫切需要确定转移性癌症的最合适治疗策略，以及为铂耐药性疾病找到有效的二线治疗选择。可以合理预期，未来的临床试验将回答这些以及其他未解决的问题，就像过去精心设计的研究使这类恶性肿瘤女性患者的生存率和生活质量都得到了显著提高一样。
