Conte P F, Gadducci A, Fioretti P, Bruzzone M, Brunetti I, Ragni N
GONO Head Quarters, St. Chiara Hospital, Pisa, Italy.
Eur J Gynaecol Oncol. 1994;15(4):313-9.
The North West Oncology Group is a cooperative group that has carried out several clinical trials on the treatment of ovarian carcinoma in the last 10 years. In a randomized study of advanced ovarian carcinoma patients, the combination of cisplatin plus cyclophosphamide (PC) came out as superior to cisplatin plus cyclophosphamide plus doxorubicin in terms of complete clinical and pathological response rates and 8-years progression free survival (PFS). A randomized trial showed that PAC and cyclophosphamide plus doxorubicin plus carboplatin (CAC) were equivalent in terms of objective response (OR) rates, pathologic complete response (pCR) rates, median survival (S) and median PFS. After PAC or CAC therapy, patients with pCR or minimal residual disease were included in a randomized trial comparing abdominopelvic radiotherapy (RT) versus 3 more courses of the chemotherapy they had received before. This study was stopped early because of a clear advantage in S and PFS for chemotherapy arm. Patients with macroscopic residual disease at second-look surgery and patients with progressing or relapsing disease after first line chemotherapy crossed to an alternative analogue: from PAC to carboplatin and from CAC to cisplatin. An OR was obtained in 25% of the patients of the cisplatin arm and in only 9% of the patients of carboplatin arm. Randomized clinical trials analyzing the role of intraperitoneal administration of chemotherapy and the role of biological response modifiers such as interferons in the treatment of patients with advanced epithelial ovarian carcinoma are currently ongoing.
西北肿瘤学组是一个合作组织，在过去10年里开展了多项卵巢癌治疗的临床试验。在一项针对晚期卵巢癌患者的随机研究中，顺铂加环磷酰胺（PC）联合方案在完全临床和病理缓解率以及8年无进展生存期（PFS）方面优于顺铂加环磷酰胺加多柔比星联合方案。一项随机试验表明，PAC方案与环磷酰胺加多柔比星加卡铂（CAC）方案在客观缓解（OR）率、病理完全缓解（pCR）率、中位生存期（S）和中位PFS方面相当。在接受PAC或CAC治疗后，pCR或微小残留病患者被纳入一项随机试验，比较腹盆腔放疗（RT）与他们之前接受的3个疗程化疗。由于化疗组在S和PFS方面具有明显优势，该研究提前终止。二次探查手术时有肉眼可见残留病的患者以及一线化疗后病情进展或复发的患者改用另一种类似方案：从PAC改为卡铂，从CAC改为顺铂。顺铂组25%的患者获得了OR，而卡铂组只有9%的患者获得了OR。目前正在进行随机临床试验，分析腹腔内化疗的作用以及生物反应调节剂如干扰素在晚期上皮性卵巢癌患者治疗中的作用。
