Hirabayashi K
Dept. of Obstet. and Gynecol., Fukuyama National Hospital.
Gan To Kagaku Ryoho. 1990 Sep;17(9):1856-63.
Significant prolongation of survival time has been brought by cisplatin containing regimen, but no significant improvement of 5 year survival rate has been achieved. Concerning to four clinical problems we face to now, my opinion was described as follows. 1) Importance of chemotherapy in the treatment of advanced ovarian cancer: The most important factor for the cure of advanced ovarian cancer is the efficacy of the regimen used. 2) Regimen and number of cycles needed: Cisplatin and carboplatin are dose-dependent drugs and we should make effort to make dose up as much as possible. May be 6 cycles will be suitable number of administration. 3) Postoperative chemotherapy or preoperative chemotherapy (Neo-adjuvant)?: Serous adenocarcinoma is observed with high frequency around 70% and the efficacy rate of cisplatin containing regimen is exceeded more than 80%. Neo-adjuvant chemotherapy should be tried in advanced ovarian cancer. 4) Second line chemotherapy: At present, no effective drug is available for the treatment of true cisplatin refractory cancer. Therefore we should perform aggressive surgery and severe chemotherapy at the first time of treatment. By combination of surgery and chemotherapy, at least clinical CR (Complete resection or complete response) is indispensable for achieving significant improvement of 5 year survival rate, In this meaning, chemotherapeutic CR is necessary in postoperative chemotherapy and surgical CR is required in Neo-adjuvant chemotherapy.
含顺铂方案显著延长了生存时间，但5年生存率并未得到显著提高。关于我们目前面临的四个临床问题，我的观点如下。1）化疗在晚期卵巢癌治疗中的重要性：治愈晚期卵巢癌的最重要因素是所用方案的疗效。2）方案及所需疗程数：顺铂和卡铂是剂量依赖性药物，我们应努力尽可能提高剂量。可能6个疗程是合适的给药次数。3）术后化疗还是术前化疗（新辅助化疗）？：浆液性腺癌的发生率较高，约为70%，含顺铂方案的有效率超过80%。晚期卵巢癌应尝试新辅助化疗。4）二线化疗：目前，对于真正对顺铂耐药的癌症，没有有效的治疗药物。因此，我们应在首次治疗时进行积极的手术和强化化疗。通过手术和化疗的联合，至少临床完全缓解（完全切除或完全缓解）对于显著提高5年生存率是必不可少的。从这个意义上说，术后化疗需要化疗完全缓解，新辅助化疗需要手术完全缓解。
