Engelen M J A, Snel B J, Schaapveld M, Pras E, de Vries E G E, Gietema J A, van der Zee A G J, Willemse P H B
Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Department of Epidemiology and Statistics, Comprehensive Cancer Centre North Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands.
Eur J Cancer. 2009 May;45(7):1193-1200. doi: 10.1016/j.ejca.2009.01.006. Epub 2009 Feb 7.
The aim of the study was to evaluate long-term toxicity of adjuvant treatment in early stage ovarian cancer survivors. Data from all patients treated in one hospital for early stage ovarian cancer diagnosed between 1980 and 1990 were collected using a structured data form. In 93 FIGO stages I and II patients, cytoreductive and staging surgery was performed; 15 received no adjuvant treatment (controls), 39 whole abdominal radiotherapy (WART) and 39 platin-based chemotherapy. Median age at diagnosis was 54 years (range 21-83 years). During follow-up, 49/93 (53%) patients have died with a median overall survival of 18.4 years (95% CI 12.8-23.9). In both the radiotherapy and the chemotherapy group, 50% of patients reported long-term side-effects (all grades) versus 13% of controls. Two patients in the WART group died from bowel complications. Secondary malignancies were observed in 16 patients. Of all patients alive at the last follow-up, 12/17 (71%) patients treated with radiotherapy and 11/18 (61%) treated with chemotherapy experienced long-term morbidity versus 2/9 (22%) controls (P=0.03).
Long-term follow-up of early stage ovarian cancer patients showed lasting GI morbidity in the survivors treated with adjuvant radiotherapy, which has therefore become obsolete. Cisplatin-based chemotherapy caused peripheral neuropathy versus virtual absence of problems in the survivors of just surgery, emphasising the need for strict criteria before instigating adjuvant treatment.
本研究的目的是评估早期卵巢癌幸存者辅助治疗的长期毒性。使用结构化数据表格收集了1980年至1990年间在一家医院接受治疗的所有早期卵巢癌患者的数据。93例国际妇产科联盟（FIGO）I期和II期患者接受了细胞减灭术和分期手术；15例未接受辅助治疗（对照组），39例接受全腹放疗（WART），39例接受铂类化疗。诊断时的中位年龄为54岁（范围21 - 83岁）。随访期间，93例患者中有49例（53%）死亡，中位总生存期为18.4年（95%置信区间12.8 - 23.9）。放疗组和化疗组中，50%的患者报告有长期副作用（所有级别），而对照组为13%。WART组有2例患者死于肠道并发症。16例患者观察到继发性恶性肿瘤。在最后一次随访时仍存活的所有患者中，放疗组12/17（71%）、化疗组11/18（61%）的患者有长期发病情况，而对照组为2/9（22%）（P = 0.03）。
早期卵巢癌患者的长期随访显示，接受辅助放疗的幸存者存在持久的胃肠道发病情况，因此这种治疗方式已过时。基于顺铂的化疗导致周围神经病变，而仅接受手术的幸存者几乎没有问题，这强调了在开始辅助治疗前需要严格的标准。
