University Hospitals Leuven, Leuven, Belgium.
Eur J Cancer. 2011 Sep;47 Suppl 3:S88-92. doi: 10.1016/S0959-8049(11)70152-6.
Advanced ovarian cancer has a poor prognosis. De-bulking surgery and platinum-based chemotherapy are the cornerstones of the treatment. Primary debulking surgery has been the standard of care in advanced ovarian cancer. Recently a new strategy with neoadjuvant chemotherapy followed by interval debulking surgery has been developed. In a recently published randomised trial of the EORTC-NCIC (European Organisation for Research and Treatment of Cancer - National Cancer Institute Canada) in patients with extensive stage IIIc and IV ovarian cancer it was shown that the survival was similar for patients randomised to neoadjuvant chemotherapy followed by interval debulking compared to primary debulking surgery, followed by chemotherapy. The post-operative complications and mortality rates were lower after interval debulking than after primary debulking surgery. The most important independent prognostic factor for overall survival was no residual tumour after primary or interval debulking surgery. In some patients obtaining the goal of no residual tumour at interval debulking is difficult due to chemotherapy-induced fibrosis. On the other hand the patients randomised had very extensive stage IIIc and IV disease and in patients with metastases smaller than 5 cm the survival tended to be better after primary debulking surgery. Hence, selection of the correct patients with stage IIIc or IV ovarian cancer for primary debulking or neoadjuvant chemotherapy followed by interval debulking surgery is important. Besides imaging with CT, diffusion MRI and/or PET-CT, also laparoscopy can play an important role in the selection of patients. It should be emphasised that the group of patients included in this study had extensive stage IIIc or IV disease. Surgical skills, especially in the upper abdomen, remain pivotal in the treatment of advanced ovarian cancer. However, very aggressive surgery should be tailored according to the general condition and extent of the disease of the patients. Otherwise, this type of aggressive surgery will result in unnecessary postoperative morbidity and mortality without improving survival. Hence, neoadjuvant chemotherapy should not be an easy way out, but is in some patients with stage IIIc or IV ovarian cancer a better alternative treatment option than primary debulking. According to the current treatment algorithm at the University Hospitals Leuven about 50% of the patients with stage IIIc or IV ovarian cancer are selected for neoadjuvant chemotherapy.
晚期卵巢癌预后较差。肿瘤细胞减灭术和铂类为基础的化疗是治疗的基石。初次肿瘤细胞减灭术是晚期卵巢癌的标准治疗方法。最近，一种新的策略，即新辅助化疗后间隔肿瘤细胞减灭术已经发展起来。在最近发表的一项由欧洲癌症研究与治疗组织-加拿大国家癌症研究所（EORTC-NCIC）进行的随机试验中，对广泛期 IIIc 和 IV 期卵巢癌患者进行了研究，结果表明，接受新辅助化疗后间隔肿瘤细胞减灭术与初次肿瘤细胞减灭术加化疗相比，患者的生存情况相似。间隔肿瘤细胞减灭术后的术后并发症和死亡率低于初次肿瘤细胞减灭术。初次或间隔肿瘤细胞减灭术后无残留肿瘤是总生存的最重要独立预后因素。在一些患者中，由于化疗引起的纤维化，达到间隔肿瘤细胞减灭术无残留肿瘤的目标是困难的。另一方面，接受随机分组的患者患有非常广泛的 IIIc 和 IV 期疾病，在转移灶小于 5cm 的患者中，初次肿瘤细胞减灭术的生存情况更好。因此，对于 IIIc 或 IV 期卵巢癌患者，选择正确的患者进行初次肿瘤细胞减灭术或新辅助化疗后间隔肿瘤细胞减灭术非常重要。除了 CT、扩散 MRI 和/或 PET-CT 成像外，腹腔镜也可以在患者选择中发挥重要作用。应该强调的是，这项研究纳入的患者群体患有广泛的 IIIc 或 IV 期疾病。手术技能，特别是在上腹部，在晚期卵巢癌的治疗中仍然至关重要。然而，非常激进的手术应该根据患者的一般状况和疾病的严重程度来调整。否则，这种类型的激进手术将导致不必要的术后发病率和死亡率，而不会提高生存率。因此，新辅助化疗不应成为一种简单的出路，而是在某些 IIIc 或 IV 期卵巢癌患者中，是比初次肿瘤细胞减灭术更好的替代治疗选择。根据鲁汶大学医院目前的治疗方案，约有 50%的 IIIc 或 IV 期卵巢癌患者被选择接受新辅助化疗。
