Young R C, Brady M F, Walton L A, Homesley H D, Averette H E, Long H J
Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Cancer. 1993 Jan 15;71(2 Suppl):601-5. doi: 10.1002/cncr.2820710217.
The appropriate therapy for patients with localized (FIGO Stage I and II) ovarian cancer has been poorly defined for all age groups and particularly for the elderly. Few prospective randomized comparisons of adjuvant therapy after careful surgical staging have been performed. The Gynecologic Oncology Group (GOG) has performed a series of trials testing adjuvant treatment in carefully staged patients with early-stage ovarian cancer. Early trials included few elderly patients but the most recent trial (GOG 95) included 18% over the age of 65 years.
Comprehensive surgical staging defined by protocol is performed before randomization. Patients with predefined stages and histologies are included and the patients are randomized prospectively to receive either intraperitoneal phosphorus-32 or three monthly cycles of cyclophosphamide and cisplatin. Assessment of the value of this adjuvant therapy will depend on survival, disease-free survival, and relapse pattern differences between the two adjuvant therapies.
This is an ongoing clinical trial and insufficient numbers of patients have been randomized for definitive conclusions. There have been seven recurrences on both arms of the trial with a median time to recurrence of 14 months. There currently are no significant age differences between relapsed patients and disease-free patients. At this point, 12 elderly patients have been randomized to each of the arms of therapy.
Although no apparent survival differences exist for elderly patients in the most recent adjuvant chemotherapy trial of early ovarian cancer, the number of patients with cancer randomized and follow-up are insufficient to establish such a difference. Currently there is no evidence that elderly patients display a significant difference in relapse frequency or pattern.
对于所有年龄组，尤其是老年患者，局限性（国际妇产科联盟[FIGO] I期和II期）卵巢癌患者的合适治疗方法一直未明确界定。在仔细进行手术分期后，很少有关于辅助治疗的前瞻性随机对照研究。妇科肿瘤学组（GOG）开展了一系列试验，对经过仔细分期的早期卵巢癌患者的辅助治疗进行测试。早期试验纳入的老年患者很少，但最近的试验（GOG 95）纳入了18%年龄超过65岁的患者。
在随机分组前，按照方案进行全面的手术分期。纳入具有预定义分期和组织学类型的患者，并将患者前瞻性随机分组，分别接受腹腔内注射磷-32或每三个月进行一个周期的环磷酰胺和顺铂治疗。对这种辅助治疗价值的评估将取决于两种辅助治疗在生存率、无病生存率和复发模式方面的差异。
这是一项正在进行的临床试验，随机分组的患者数量不足，无法得出确定性结论。试验的两组均有7例复发，复发的中位时间为14个月。目前，复发患者和无病患者之间在年龄上没有显著差异。此时，每组治疗方法均有12例老年患者被随机分组。
尽管在最近一项早期卵巢癌辅助化疗试验中，老年患者在生存率上没有明显差异，但随机分组的癌症患者数量和随访时间不足以确定这种差异。目前没有证据表明老年患者在复发频率或模式上存在显著差异。
