Hilpert F, Krause G, Venhoff L, Kühnle E, Schem C, Maass N
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
Ther Umsch. 2007 Jul;64(7):375-80. doi: 10.1024/0040-5930.64.7.375.
Ovarian cancer (OC) is associated with the highest cancer-related mortality among gynecological cancers, since nearly 2/3 of patients are diagnosed with advanced stage disease which is caused by an unspecific clinical appearance and the lack of effective early detection methods. So far only histopathological and clinical prognostic factors have clinical relevance from which FIGO-stage and the postoperative residual disease have predominant importance. Early stage OC (FIGO Ia-II) has a good prognosis with survival rates of approximately 90%, provided that the tumor is macroscopically resected and an adequate surgical staging has been performed. Additionally early stage OC patients should receive an adjuvant platinum-based chemotherapy. In advanced stage OC (FIGO IIb-IV) the aim of primary surgery is a maximum cytoreduction. Additionally, postoperative treatment is performed with carboplatin/paclitaxel for six cycles. So far there are no data to support the introduction of non-cross-resistant agents, dose escalation or prolongation of therapy. The majority of advanced stage patients relapse despite optimal primary therapy. Treatment of recurrent disease follows palliative considerations and should serve symptom control and tumor regression and especially quality of life. The prognosis of recurrent disease differs extensively according to the length of the progression-free survival and response to primary platinum-based chemotherapy and is differentiated into platinum-refractory and platinum-sensitive disease. Platinum-refractory OC generally have an extensive chemoresistance against all available cytostatic agents. Various mono-chemotherapies do not exceed response rates of 20%. In contrast, platinum-sensitive recurrent OC have a much more favourable prognosis due to response rates of 30-50% with platinum-based combination therapies. Another operation seems to be only reasonable in case of platinum-sensitive recurrent disease and if the tumor can be macroscopically resected with no residual tumor The aftercare in OC should focus on the detection of recurrent disease and the detection and therapy of maintained treatment related toxicities as well as psycho-oncological aspects.
卵巢癌（OC）在妇科癌症中与最高的癌症相关死亡率相关，因为近三分之二的患者被诊断为晚期疾病，这是由不特异的临床表现和缺乏有效的早期检测方法所致。到目前为止，只有组织病理学和临床预后因素具有临床相关性，其中国际妇产科联盟（FIGO）分期和术后残留病灶最为重要。早期OC（FIGO Ia-II期）预后良好，生存率约为90%，前提是肿瘤在肉眼下被切除且进行了充分的手术分期。此外，早期OC患者应接受辅助铂类化疗。在晚期OC（FIGO IIb-IV期）中，初次手术的目的是最大程度地减瘤。此外，术后用卡铂/紫杉醇进行六个周期的治疗。到目前为止，尚无数据支持引入非交叉耐药药物、增加剂量或延长治疗时间。尽管进行了最佳的初次治疗，大多数晚期患者仍会复发。复发性疾病遵循姑息治疗原则，应致力于症状控制、肿瘤消退，尤其是生活质量。复发性疾病的预后根据无进展生存期的长短以及对初次铂类化疗的反应有很大差异，可分为铂类难治性和铂类敏感性疾病。铂类难治性OC通常对所有可用的细胞毒性药物具有广泛的化疗耐药性。各种单一化疗的有效率不超过20%。相比之下，铂类敏感性复发性OC的预后要好得多，因为铂类联合疗法的有效率为30%-50%。另一次手术似乎仅在铂类敏感性复发性疾病且肿瘤可在肉眼下切除且无残留肿瘤的情况下才合理。OC的随访应侧重于复发性疾病的检测、维持治疗相关毒性的检测和治疗以及心理肿瘤学方面。
