Eltabbakh G H, Piver M S, Hempling R E, Recio F O, Blumenson L E
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
Gynecol Oncol. 1998 Nov;71(2):190-5. doi: 10.1006/gyno.1998.5112.
The aim of this study was to determine the potential benefit and complications of prolonged salvage and maintenance chemotherapy among patients with recurrent epithelial ovarian cancer who achieve response to salvage chemotherapy.
Patients with recurrent platinum-sensitive epithelial ovarian cancer who were treated between 1982 and 1996 and achieved complete response to platinum-based salvage chemotherapy were offered prolonged (1 year) monthly salvage followed by maintenance (every 8 weeks) chemotherapy. Patients who accepted such treatment (n = 16) were compared to those who refused and discontinued therapy (n = 11) with regard to overall survival from time of initial diagnosis and overall and disease-free survival from time of recurrence. Chemotherapy-related toxicity in the study group was recorded. Survival curves were constructed according to the Kaplan and Meier method and survival curves were compared using the log-rank test.
Patients in the study and control groups were similar with regard to age, stage, histology, grade, performance status, primary cytoreductive surgery, type of primary and salvage chemotherapy, and method of assessment of tumor response. The study group had a significantly longer disease-free interval from date of recurrence than the control group (median: 35.0 versus 6.0 months, respectively, P = 0.001). The study group had longer overall survival from date of recurrence than the control group. However, the difference did not achieve statistical significance (median: 119 versus 90 months, respectively, P = 0.056). There was no significant difference between the study group and the control group as to survival from date of initial diagnosis (median: 157 versus 124 months, respectively, P = 0.28). Chemotherapy-related toxicity was minimal.
Prolonged salvage and maintenance chemotherapy is a safe method of treatment that may extend disease-free interval among patients with platinum-sensitive recurrent epithelial ovarian cancer who achieve response to salvage chemotherapy. These preliminary results need to be confirmed by a larger prospective randomized trial.
本研究旨在确定对挽救性化疗有反应的复发性上皮性卵巢癌患者接受延长疗程的挽救及维持化疗的潜在益处和并发症。
1982年至1996年间接受治疗且对铂类挽救性化疗达到完全缓解的复发性铂敏感上皮性卵巢癌患者，接受为期1年的每月一次挽救性化疗，随后进行维持（每8周一次）化疗。将接受此类治疗的患者（n = 16）与拒绝并中断治疗的患者（n = 11）在从初始诊断时间起的总生存期以及从复发时间起的总生存期和无病生存期方面进行比较。记录研究组中与化疗相关的毒性。根据Kaplan-Meier方法构建生存曲线，并使用对数秩检验比较生存曲线。
研究组和对照组患者在年龄、分期、组织学、分级、体能状态、初次细胞减灭术、初次和挽救性化疗类型以及肿瘤反应评估方法方面相似。研究组从复发日期起的无病间期明显长于对照组（中位数分别为35.0个月和6.0个月，P = 0.001）。研究组从复发日期起的总生存期长于对照组。然而，差异未达到统计学意义（中位数分别为119个月和90个月，P = 0.056）。研究组和对照组在从初始诊断日期起的生存期方面无显著差异（中位数分别为157个月和124个月，P = 0.28）。与化疗相关的毒性极小。
延长疗程的挽救及维持化疗是一种安全的治疗方法，可能会延长对挽救性化疗有反应的铂敏感复发性上皮性卵巢癌患者的无病间期。这些初步结果需要通过更大规模的前瞻性随机试验来证实。
