Chambers J T, Chambers S K, Kohorn E I, Carcangiu M L, Schwartz P E
Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut 06520, USA.
Gynecol Oncol. 1996 Mar;60(3):438-42. doi: 10.1006/gyno.1996.0070.
This study was designed to evaluate the efficacy of intraperitoneal cisplatin and intravenous doxorubicin and cyclophosphamide in patients with uterine papillary serous carcinoma. Sixteen patients with uterine papillary serous carcinoma underwent complete surgical staging and placement of an intraperitoneal port. Postoperatively, they received cisplatin (100 mg/m2) given intraperitoneally and doxorubicin (50 mg/m2) intravenously and cyclophosphamide (600 mg/m2) intravenously every 4 weeks for 6 cycles. The intraperitoneal ports did not function in 3 patients immediately following surgery. The remaining 13 patients constitute the study group. The patients ranged in age from 37 to 77 years. There were 1 patient with Stage IA, 3 with Stage IB, 2 with Stage IIB, 2 with Stage IIIA, 2 with Stage IIIC, 1 with Stage IVA, and 2 with Stage IVB. At the end of surgery no gross residual disease remained except for 1 patient who had less than 1-cm nodules in the peritoneal cavity. Eleven of the patients underwent 6 cycles of chemotherapy, 1 patient underwent 3 cycles, and 1 patient underwent 1 cycle. A total of 71 cycles of chemotherapy were given. All patients developed alopecia. Two patients developed neutropenic fever, one was treated with antibiotics, the other patient died from urosepsis. One patient had a > 15% decrease in left ventricular ejection fraction which led to a dose reduction of doxorubicin. One patient had a urinary tract infection and one patient developed a port infection which necessitated its removal. Seven patients have died, 1 is alive with disease, and 5 patients are alive with no evidence of disease. Five of the 7 patients with extrauterine disease have died of disease. One is alive with disease and the other is free of disease. The media survival of these patients was 34 months with an overall 3 years survival of only 24.1%. Although the protocol was reasonably well tolerated, the overall survival did not differ from that of a similar group of patients treated at our institution with intravenous chemotherapy. There was a high incidence of dysfunction of the intraperitoneal ports (25%). This approach with intraperitoneal cisplatin presents no therapeutic advantage for these patients.
本研究旨在评估腹腔内注射顺铂联合静脉注射阿霉素及环磷酰胺治疗子宫乳头状浆液性癌患者的疗效。16例子宫乳头状浆液性癌患者接受了完整的手术分期及腹腔置管。术后，患者每4周接受一次腹腔内注射顺铂（100mg/m²）、静脉注射阿霉素（50mg/m²）及静脉注射环磷酰胺（600mg/m²），共6个周期。3例患者术后腹腔置管立即出现功能障碍。其余13例患者构成研究组。患者年龄在37至77岁之间。其中IA期1例，IB期3例，IIB期2例，IIIA期2例，IIIC期2例，IVA期1例，IVB期2例。手术结束时，除1例患者腹腔内有小于1cm的结节外，无肉眼可见的残留病灶。11例患者接受了6个周期的化疗，1例患者接受了3个周期的化疗，1例患者接受了1个周期的化疗。共进行了71个周期的化疗。所有患者均出现脱发。2例患者发生中性粒细胞减少性发热，1例接受抗生素治疗，另1例死于尿脓毒症。1例患者左心室射血分数下降超过15%，导致阿霉素剂量减少。1例患者发生尿路感染，1例患者发生置管感染，需拔除置管。7例患者死亡，1例带瘤生存，5例无疾病生存。7例有子宫外疾病的患者中有5例死于疾病。1例带瘤生存，另1例无疾病生存。这些患者的中位生存期为34个月，3年总生存率仅为24.1%。尽管该方案耐受性较好，但总体生存率与我院接受静脉化疗的类似患者组相比并无差异。腹腔置管功能障碍发生率较高（25%）。这种腹腔内注射顺铂的方法对这些患者没有治疗优势。
