Szepesi T, Szalay S, Breitenecker G, Schratter-Sehn A, Rogan A M, Riss T, Wittich G, Heckenthaler W, Fasching W, Scheiber V
Wien Klin Wochenschr. 1983 Jan 21;95(2):37-49.
From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.
1977年2月至1981年2月，我们对55例卵巢癌患者（45例Ⅲ期和10例Ⅳ期）进行了同步放化疗；其中34例患者接受了二次治疗性探查手术。总缓解率为94%，包括63%的完全缓解和31%的部分缓解。在初次手术后残留肿瘤直径超过2 cm的患者组中，观察到52%的完全缓解。在Ⅲ期组中，完全缓解率为74%，部分缓解率为26%。在74%的此类病例中，通过早期二次探查手术实现了肿瘤细胞减灭至小于2 cm。这些患者的预后与初次切除后残留肿瘤相当的患者相同。与肿瘤扩散至腹膜后区域的病例不同，肿瘤肉眼扩散至肝脏或膈肌表面提示预后较差。诊断性手术时证实无肿瘤的患者的生存时间明显长于有残留肿瘤的患者。患者的年龄和初次手术后的组织学结果对生存时间均无显著影响。晚期肠道并发症使我们自1981年3月起改变了所采用的治疗策略，采用序贯放化疗。Ⅲ期患者只有通过多学科合作才有可能治愈。在Ⅳ期患者中，预后很差，只有在特定病例中才可能进行局部治疗。
