Yakushiji M, Sugiyama T
Dept. of Obstetrics and Gynecology, Kurume University School of Medicine.
Gan To Kagaku Ryoho. 1988 Jun;15(6):1855-62.
In recent years, chemotherapy has markedly advanced after cisplatin became available. In addition, it has recently been found that the efficacy of chemotherapy differs according to the diameter of the residual tumor (less than 2 approximately 3 cm). For these reasons, debulking or cytoreduction surgery has been frequently carried out in advanced cancer cases to reduce the diameter of tumors. Basic procedures adopted by an increasing number of medical institutions are bilateral adnexectomy + simple total hysterectomy and omentectomy. In addition, since lymph node metastasis is found even in early cancer cases, dissection of lymph nodes extending from the pelvic lymph node to the paraaortic lymph node is now considered to be essential, and is referred to also by the FIGO's new classification of cancer stages. SLO is also important in judging the necessity of excising a residual tumor and assessing therapeutic efficacy. In chemotherapy, high effectiveness rates have been reported chiefly for cisplatin + CAP therapy in epithelial tumor cases and cisplatin + VAC or VBP therapy in germ cell tumor cases. However, since the effect of cisplatin in second and third lines is not satisfactory, development of new platinum compounds and studies of more effective regimens (such as massive cisplatin therapy) are now being performed. Radiation therapy, on the other hand, is merely an auxiliary therapy at present.
近年来，自顺铂问世后化疗有了显著进展。此外，最近发现化疗疗效因残留肿瘤直径不同而有所差异（小于2至3厘米左右）。基于这些原因，在晚期癌症病例中经常进行肿瘤减积或细胞减灭手术以缩小肿瘤直径。越来越多医疗机构采用的基本手术方式是双侧附件切除术 + 单纯全子宫切除术及大网膜切除术。另外，由于即使在早期癌症病例中也会发现淋巴结转移，现在认为从盆腔淋巴结到腹主动脉旁淋巴结的淋巴结清扫至关重要，国际妇产科联盟（FIGO）癌症分期新分类中也提及了这一点。血清乳酸脱氢酶（SLO）在判断切除残留肿瘤的必要性及评估治疗效果方面也很重要。在化疗方面，上皮性肿瘤病例中主要是顺铂 + 环磷酰胺、阿霉素、顺铂（CAP）疗法，生殖细胞肿瘤病例中是顺铂 + 长春新碱、放线菌素D、环磷酰胺（VAC）或顺铂、博来霉素、长春新碱（VBP）疗法，均报告有较高有效率。然而，由于顺铂在二线和三线治疗中的效果不尽人意，目前正在研发新的铂类化合物并研究更有效的治疗方案（如大剂量顺铂疗法）。另一方面，放射治疗目前仅仅是一种辅助治疗。
