Schwartz P E, Chambers J T, Makuch R
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510.
Gynecol Oncol. 1994 Apr;53(1):33-7. doi: 10.1006/gyno.1994.1083.
The purpose of this study was to compare the survival of women with clinical, radiologic, and histologic findings compatible with advanced ovarian cancer who were treated with neoadjuvant chemotherapy to that of a group of women with FIGO stage IIIC (suboptimal debulking) and stage IV epithelial ovarian cancers treated with the same chemotherapy. Eleven women with physical, radiologic, and histologic findings compatible with advanced ovarian cancer (median age, 73 years) treated with neoadjuvant carboplatin and cyclophosphamide chemotherapy were compared to 18 women (median age, 60 years) who had stage III and suboptimal surgical cytoreduction (> 2 cm residual tumor, 13 patients) or stage IV (5 patients) ovarian cancer followed by the same chemotherapy. The progression-free survival for the 11 women receiving neoadjuvant chemotherapy was 9.1 months which was not statistically different from the 8.5 months progression-free survival for the 18 women with suboptimally debulked stage IIIC or stage IV disease (P = 0.98). The overall survival was not significantly different (P = 0.26). Neoadjuvant-treated patients tended to tolerate chemotherapy better as none required dose reduction for bone marrow suppression, while 6 of 18 conventionally treated patient required dose reductions. In conclusion, neoadjuvant chemotherapy appears to be an effective means of palliating women with clinical, radiological, and histologic findings compatible with advanced ovarian cancer. A prospective study is necessary in which women with findings compatible with advanced ovarian cancer that is not likely to be effectively cytoreduced surgically are randomized to either undergo cytoreductive surgery followed by chemotherapy or receive neoadjuvant chemotherapy.
本研究的目的是比较接受新辅助化疗的、临床、影像学和组织学检查结果符合晚期卵巢癌的女性患者的生存率，与一组FIGO IIIC期（减瘤不彻底）和IV期上皮性卵巢癌且接受相同化疗的女性患者的生存率。将11例身体检查、影像学和组织学检查结果符合晚期卵巢癌（中位年龄73岁）且接受新辅助卡铂和环磷酰胺化疗的女性患者，与18例（中位年龄60岁）卵巢癌患者进行比较，这18例患者中，13例为III期且减瘤不彻底（残留肿瘤>2 cm），5例为IV期，她们均接受了相同化疗，且先行手术减瘤。接受新辅助化疗的11例女性患者的无进展生存期为9.1个月，与18例减瘤不彻底的IIIC期或IV期疾病女性患者的8.5个月无进展生存期相比，差异无统计学意义（P = 0.98）。总生存期差异也无统计学意义（P = 0.26）。接受新辅助治疗的患者对化疗的耐受性往往更好，因为无人因骨髓抑制而需要降低剂量，而18例接受传统治疗的患者中有6例需要降低剂量。总之，新辅助化疗似乎是缓解临床、影像学和组织学检查结果符合晚期卵巢癌的女性患者症状的有效方法。有必要进行一项前瞻性研究，将临床、影像学和组织学检查结果符合晚期卵巢癌且手术不太可能有效减瘤的女性患者随机分组，一组先进行减瘤手术然后化疗，另一组接受新辅助化疗。
