Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil..
Instituto do Cancer do Estado de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo CEP: 01246-000, Brazil.
Gynecol Oncol. 2014 Feb;132(2):287-91. doi: 10.1016/j.ygyno.2013.12.002. Epub 2013 Dec 9.
Three cycles of neoadjuvant chemotherapy (NACT) followed by interval debulking (ID) surgery is an alternative for patients with advanced ovarian cancer unresectable disease. This study aimed to determine the efficacy and safety of six cycles of NACT followed by cytoreduction.
Retrospective analysis of all patients with advanced epithelial ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma treated with platinum based NACT between January 2008 and February 2012.
Eighty-two patients underwent NACT; 78% and 18.2% had extensive stage IIIC or IV disease at diagnosis, respectively. Their median age was 60 years (41-82). On histology, serous adenocarcinoma was found in 90.2%. Patients did not receive chemotherapy after debulking surgery. 35.4% suffered grade 3/4 toxicity; the most commonly observed toxicities were hematologic and nausea. After NACT, 23.1% experienced clinical complete response, 57.4% partial response, and 12.1% disease progression. Complete resection of all macroscopic and microscopic disease (R0) was performed in 63.7%. Surgical complications were uncommon; however, four (6.2%) patients needed a second procedure due to operative complications and 18 (27.3%) needed blood transfusion after debulking. Over a median follow-up period of 19.2 months, median overall survival and chemotherapy-free interval were 37.5 months (confidence interval not reached) and 16 months, respectively.
Six cycles of neoadjuvant carboplatin and paclitaxel was safe and effective and did not increase perioperative or postoperative complications in patients with stage IIIC/IV disease who were unsuitable for optimal PDS. The overall survival of this cohort was higher than that of those treated with ID surgery.
对于无法切除的晚期卵巢癌患者，新辅助化疗（NACT）加间隔减瘤术（ID）是一种替代方案。本研究旨在确定六周期 NACT 加细胞减灭术的疗效和安全性。
回顾性分析 2008 年 1 月至 2012 年 2 月期间接受铂类 NACT 治疗的所有晚期上皮性卵巢癌、输卵管癌或原发性腹膜癌患者。
82 例患者接受 NACT；78%和 18.2%的患者在诊断时分别为广泛期 III 期或 IV 期疾病；中位年龄为 60 岁（41-82 岁）。组织学上，发现 90.2%的浆液性腺癌。减瘤术后患者未接受化疗。35.4%的患者出现 3/4 级毒性；最常见的毒性是血液学毒性和恶心。NACT 后，23.1%的患者达到临床完全缓解，57.4%的患者部分缓解，12.1%的患者疾病进展。63.7%的患者达到所有宏观和微观疾病（R0）完全切除。手术并发症不常见；然而，有 4 例（6.2%）患者因手术并发症需要再次手术，18 例（27.3%）患者在减瘤后需要输血。在中位随访 19.2 个月期间，中位总生存期和无化疗间期分别为 37.5 个月（未达到置信区间）和 16 个月。
对于不适合最佳 PDS 的 IIIIC/IV 期疾病患者，六周期卡铂联合紫杉醇新辅助化疗安全有效，不会增加围手术期或术后并发症。该队列的总生存期高于接受 ID 手术的患者。
