Varia M, Rosenman J, Venkatraman S, Askin F, Fowler W, Walton L, Halle J, Currie J
Division of Radiation Oncology, University of North Carolina, Chapel Hill 27514.
Cancer. 1988 Mar 1;61(5):919-27. doi: 10.1002/1097-0142(19880301)61:5<919::aid-cncr2820610511>3.0.co;2-p.
Between 1973 and 1985, 118 patients in clinical remission after initial surgery and postoperative chemotherapy for epithelial ovarian carcinoma underwent second-look laparotomy at the University of North Carolina. No evidence of disease (NED) was found in 57 of these patients; 43 patients received 15 mCi of radioactive chromic phosphate (32P) suspension given intraperitoneally in the immediate postoperative period. In 29 other patients, only microscopic or minimal residual disease (nodules less than 2 cm in size) was found, seven received 32P alone, ten received 32P and further chemotherapy, and 12 received chemotherapy alone. The 4-year postsecond-look survival of the patients with NED at second-look was 89% for those receiving 32P and 67% for those who had not. The respective figures for patients with minimal residual disease at second-look are 59% versus 22%. Irrespective of treatment, a group at high risk for failure after negative second-look laparotomy has been identified; those with an initial International Federation of Gynecology and Obstetrics (FIGO) stage greater than I and histologic grade greater than 1. A comparison of our data with 18 previously published series, indicates that use of postsecond-look intraperitoneal 32P can improve the progression-free interval, and possibly overall survival, of patients with NED or minimal residual disease without adding significant complications.
1973年至1985年间,北卡罗来纳大学对118例上皮性卵巢癌患者进行了初次手术及术后化疗,处于临床缓解期的患者接受了二次剖腹探查术。其中57例患者未发现疾病证据(NED);43例患者在术后即刻接受了15毫居里放射性磷酸铬(32P)悬浮液腹腔注射。另外29例患者仅发现微小或最小残留病灶(结节大小小于2厘米),7例仅接受32P治疗,10例接受32P及进一步化疗,12例仅接受化疗。二次探查时NED患者中,接受32P治疗的患者4年生存率为89%,未接受32P治疗的患者为67%。二次探查时最小残留病灶患者的相应数字分别为59%和22%。无论接受何种治疗,已确定二次剖腹探查阴性后有高失败风险的一组患者;即初始国际妇产科联盟(FIGO)分期大于I期且组织学分级大于1级的患者。将我们的数据与之前发表的18个系列进行比较表明,二次探查后腹腔内使用32P可改善NED或最小残留病灶患者的无进展生存期,并可能改善总生存期,且不会增加明显并发症。