Ozols R F
Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111.
Bull Cancer. 1993 Nov;80(11):955-70.
The incidence of ovarian cancer has been increasing gradually over the last 25 years. The presenting symptoms are non-specific and, in many cases, there is extensive intraabdominal spread at the time of diagnosis. Diagnosis is based on abdominal ultrasonography followed by laparotomy for tumor classification and extensive excision. Assay of CA125 can be a useful diagnostic tool for post-menopausal women, and for determining the response to treatment. Routine screening for ovarian cancer is not feasible. The most important prognostic factor is tumor extension. In early stages, chemotherapy does not improve the prognosis in "low-risk" patients, and its value in high-risk patients remains to be determined. In patients with advanced-stage ovarian carcinoma, platinum derivatives are the reference drugs. The high toxicity of cisplatin has led to the development of carboplatin, which has similar activity but virtually no nephrotoxicity, neurotoxicity or ototoxicity. Carboplatin is currently considered as the cytostatic drug of choice, as it can be given at higher doses which may improve the survival time. The possible indications for intraperitoneal chemotherapy remain to be determined. Secondary laparotomy should not be used, except in clinical trials. Taxol (paclitaxel), a new cytostatic agent that prevents mitosis through an original mode of action, is currently undergoing evaluation.
在过去25年中,卵巢癌的发病率一直在逐渐上升。其出现的症状不具有特异性,而且在许多情况下,诊断时已有广泛的腹腔内扩散。诊断基于腹部超声检查,随后进行剖腹手术以进行肿瘤分类和广泛切除。CA125检测对于绝经后女性以及确定治疗反应可能是一种有用的诊断工具。对卵巢癌进行常规筛查并不可行。最重要的预后因素是肿瘤扩散情况。在早期阶段,化疗并不能改善“低风险”患者的预后,其在高风险患者中的价值仍有待确定。对于晚期卵巢癌患者,铂类衍生物是参考药物。顺铂的高毒性促使了卡铂的研发,卡铂具有相似的活性,但几乎没有肾毒性、神经毒性或耳毒性。卡铂目前被认为是首选的细胞毒性药物,因为它可以给予更高的剂量,这可能会延长生存时间。腹腔内化疗的可能适应证仍有待确定。除非在临床试验中,否则不应进行二次剖腹手术。紫杉醇是一种新型细胞毒性药物,它通过一种独特的作用方式阻止有丝分裂,目前正在进行评估。