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Background and purpose:More than 70 percent of ovarian cancer patients were diagnosed in the advanced stage. Currently the 5-year disease free survival (DFS) of stageⅢC-Ⅳovarian cancer patients wsa about 10 percent after first line chemotherapy. This study aimed to improve the 5-year DFS by three-step chemotherapy according to the mechanisms of ovarian cancer biological characteristics, cytodynamics and pharmacology. Methods:In arm A, the patients received three-step chemotherapy after primary debulking surgery, step one with paclitaxel plus carboplatin (TC regimen), every 3 weeks for 6 to 8 cycles;step two with etoposide plus cyclophosphamide, every 4 weeks for 6 cycles;step three wit carboplatin plus cyclophosphamide every eight weeks for six cycles. In control arm B, we retrospectively analysed 51 cases withⅢC-Ⅳstage ovarian cancer, who had completely response after standard chemotherapy with six to eight cycles of TC after primary surgery during 2007. We compared the 5-year DFS between the two arms. Results:The 5-year DFS of 15 cases in arm A was 80%(12/15), which was signiifcantly higher than that of arm B (5.9%, 3/51, P<0.01). Conclusion: The three-step chemotherapy after optimal debulking surgery in stageⅢC-Ⅳ can improve the 5-year DFS. This regimen is high efficacy, mild side-effect witn low cost, which deserves further exploration.
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Objective To establish the methods of three-dimensional eonformal(3DCRT) and intensity-modulated radiotherapy(IMRT) for whole pelvic irradiation in post-hysterectomy cervical carcinoma, And to optimize the methods for clinical practice. Methods Between 2004 and 2005,10 patients with cervical carcinoma who underwent hysterectomy with high risk of recurrence were selected for this study. The following observations and measurements were used for the study: Set-up errors with supine or prone position were measured to determine appropriate immobilization position. Influence of full and empty bladder on irradiated normal tissue volume was measured. Treatment errors were detected and CTV/PTV were then delineated. 3DCRT and IMRT planning and comparison were applied. Results The set-up error was within 5 mm of three dimensions in prone position and more than 5 mm in supine position, the difference of which was statistically significant. The percentage of irradiated volume of the bladder and bowel was smaller when the bladder was full comparing with empty bladder. In prone position and with full bladder,portal films showed the movement of isocenter in three directions. The total uncertainty was [7.4±1.6]mm. For 95% confidence interval,the margin from CTV to PTV was 1 cm. CIPTV for 3,4,5,and 6 fields 3DCRT was 0.46,O. 67, O. 68, and O. 68, respectively. When beyond 4 fields, the advantage of adding fields was not significant.Four fields planning was feasible for clinical practice. CI for 5,7,9,11 ,and 13 fidds IMRT was 0.75,0.83, 0.84,0.85 ,and 0.85 ,respectively. When beyond 9 fields,the advantage of adding fields was not significant. Nine fields planning was feasible for clinical practice. Conclusions For whole pelvic radiotherapy for post-hysterectomy cervical carcinoma,prone position was better than supine position for immobilization due to smaller set-up errors. The full bladder is recommended during radiotherapy, planning,For clinical practice,4 fields planning is feasible in 3DCRT while 9 fields planning is feasible in IMRT.
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1cm, there was a significant statistical difference in median survival of 61 and 12 months, respectively (? 2 =16.60, P =0.0001). The median survival for patients with and without peritoneal chemotherapy were 27 and 12 months, respectively (? 2 =3.45, P =0.0633). Residual disease, FIGO stage, recurrent ascites, uterus muscle involvement were independent prognostic determinants of survival identified by Cox's stepwise regression analysis. Conclusions Aggressive surgical cytoreduction should be performed in elderly AEOC patients as well as in younger patients, but multi-course platinum-based chemotherapy should be used in accordance with the performance status of elder women.
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<p><b>OBJECTIVE</b>To study the role of secondary cytoreductive surgery (SCR) in patients with recurrent advanced epithelial ovarian cancer.</p><p><b>METHODS</b>From Jan. 1986 to Dec. 1997, 60 women with recurrent advanced epithelial ovarian cancer treated with SCR were retrospectively reviewed. Survival curves were computed using the Kaplan-Meier method with differences in survival estimated by log-rank test. Independent prognostic factors were identified by Cox's stepwise regression, and the affecting factors of SCR evaluated by Logistic stepwise regression.</p><p><b>RESULTS</b>Of the 60 patients, 23 (38.3%) were cytoreduced to small macroscopic residual (</= 1 cm) and 37 retained larger residual, with an estimated median survival of 19 months and 8 months respectively. Multivariate analysis revealed that residual disease (P = 0.0041) after SCR, as well as refractory ascites (P = 0.0191) and progression-free interval (P = 0.0116), were independent factors of survival. Refractory ascites (relative risk = 20.36, P = 0.0072) and residual disease after primary surgery (relative risk = 5.16, P = 0.0096) were factors affecting SCR.</p><p><b>CONCLUSION</b>Secondary cytoreductive surgery is definitely effective in the treatment of recurrent advanced epithelial ovarian carcinoma, particularly in those who have received primary optimal cytoreduction with a progression-free interval > 12 months and without refractory ascites.</p>
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Adult , Female , Humans , Middle Aged , Logistic Models , Neoplasm Recurrence, Local , General Surgery , Neoplasm, Residual , General Surgery , Ovarian Neoplasms , General Surgery , Prognosis , Survival AnalysisABSTRACT
<p><b>OBJECTIVE</b>To study the concentration change of chemotherapeutic agents in plasma and tissue after intraarterial and intravenous injection.</p><p><b>METHODS</b>Ten mature female New Zealand rabbits were divided randomly into two groups. Fluorouracil, etopiside, and cisplatin were injected into the rabbits through the ear vein in one group and through the internal iliac artery in the other group. Blood samples and the uterus tissue specimens were collected at various time points after injection. Drug concentration in plasma and tissue was determined by high performance liquid chromatography (HPLC) method. The data were analyzed by the pharmacokinetic program 3P97.</p><p><b>RESULTS</b>Regular concentration change of the three drugs in plasma and tissue was observed after the intravenous and intraarterial injection, which met the two - compartment model. The pharmacokinetic parameters of the three drugs after intravenous and intraarterial injection were different. The peak concentration in plasma after intraarterial injection was lower than that after intravenous injection and the peak concentration and area under curve (AUC) value in tissue after intraarterial injections were higher than those after intravenous injection.</p><p><b>CONCLUSION</b>Intraarterial chemotherapy has advantages to intravenous chemotherapy in fluorouracil, etopiside and cisplatin. These advantages depend on the drug pharmacological properties.</p>
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Animals , Female , Rabbits , Antineoplastic Agents , Blood , Pharmacokinetics , Cisplatin , Blood , Pharmacokinetics , Etoposide , Blood , Pharmacokinetics , Fluorouracil , Blood , Pharmacokinetics , Injections, Intra-Arterial , Injections, IntravenousABSTRACT
6 months was 42.3 months, longer than 17.5 months for patients with PFI ≤ 6 months, no statistical significance was found ( P =0.1418). Multivariate analysis strongly suggested that PFI and the courses of second line chemotherapy were independent prognostic factors of survival after secondary treatment for epithelial ovarian cancer. For those patients with PFI ≤ 6 months, the smaller the size of residual lesion ( P =0.0003) and the more the cycle of effective second line chemotherapy ( P =0.0004), the longer the survival after the secondary cytoreduction. Conclusions:The results suggested that successful secondary cytoreductive surgery combined with multicycles second line chemotherapy may be an effective way to lengthen the survival on retreatment for patients with platinum resistant and recurrent epithelial ovarian cancer.
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Purpose:In order to improve the survival rate of recurrent ovarian carcinoma, influencing factors and the effects of combined therapy of recurrent epithelial ovarian carcinoma were investigated. Methods:From January 1998 to December 2000,60 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study as research arm. The procedures of the combined treatment were as follows: After second cytoreductive surgery, platinum sensitive patients were treated with TP regimen (taxol+DDP) or CC regimen (CBP+CTX) and platinum resistant patients used TM regimen(taxol+MMC) or VM regimen(VP 16+MMC). Chemotherapy with 2/3 doses was continued after disease remission. Pelvic radiotherapy was performed for those with pelvic residual disease. IFN and/or IL 2 were administrated during chemotherapy and radiotherapy. 167 patients with recurrent epithelial ovarian carcinoma from January 1986 to December 1997, were retrospectively classified as control arm in this study. The patients were mainly treated with combined chemotherapy (CAP regimen) and traditional Chinese medicine applied as adjuvant therapy. Results:The rates of CR and PR in the research arm differed significantly from that in the control arm (43.33%, 45.00% vs. 2.99%, 7.78% P = 0.000). The 1 , 2 and 3 year survival rates of the research arm and control arm were 89.38%, 79.69%, 71.25% vs. 64.58%, 40.39%, 31.20% respectively ( P
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Objective To evaluate the effects of combined treatment for advanced epithelial ovarian carcinoma and to analyze its prognostic factors Methods Fifty three patients treated with a three step combined therapeutic regimen were defined as research arm The procedures of the three step combined treatment were as follows: induction of tumor remission, sequential chemotherapy and adjuvant immunotherapy Three hundred and eighteen patients with advanced epithelial ovarian carcinoma treated with cytoreductive surgery and systemic chemotherapy were retrospectively classified into control arm Results The rates of complete response and partial response in the research arm were significantly differed from those in the control arm (90 6%, 5 7% Vs 70 1%, 5 3%, P
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Objective To study the characteristics, therapies and prognosis of the patients with epithelial ovarian cancer (EOC) that are initially categorized as extra abdominal adenocarcinoma of unknown primary Methods Twenty five patients with EOC, who were treated in the Cancer Hospital of Fudan University from Jan 1986 to Dec 1997, and manifesting as extra peritoneal or liver parenchyma metastases at the time of presentation, without detectable ovarian tumors, were retrospectively studied Results Supraclavicular and inguinal lymph node metastases were common in this group of patients, with 6 and 5 cases respectively, and 6 patients with more than two sites metastases simultaneously 16 patients (64%) were optimally surgical debulked 20 patients with stage Ⅳ EOC initially presenting as extra abdominal metastases experienced a better prognosis, with an estimated median survival of 24 months. Of whom the median survival was 30 months in patients presenting with pleural effusion or supraclavicular lymph node metastases Vs 19 months in those with other sites spread ( P =0 026 4) Conclusions The prognosis of such cases, particularly for those with supraclavicular lymphadenopathy or malignant pleural effusion, is a lot better than other stage Ⅳ EOC patients, probably because of most of the patients initially presenting with distant metastases being generally in a good condition competent for aggressive surgery or multi cycle chemotherapy
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Objective To study the response rate and toxic side effect of Vindesine, aclarubicin and mitomycin (VAM) as a new regime of second line chemotherapy for ovarian carcinoma refractory to platinum group of drugs.Methods From June 1997 through August 1998, 25 cases of refractory ovarian carcinoma were treated with VAM regime. The response rate and the side reactions were analyzed. Results The overall response rate was 32.0%, with 3 complete response (CR) and 5 partial response (PR). In the platinum refractory, platinum-resistant platinum-senstitive strata, the response rates were 18.2% 28.6% and 57.1% respectively. Myelosuppression was the main toxic effect. Grade 3 and grade 4 neutropenia occurred in 40.0% and thrombocytopenia in 28.0% of the patients. Alopecia occurred in 32% of cases. Gastrointastinal, cardiac and neurologic toxicities were mild. Conclusion VAM regime is a practical and effective second-line chemotherapy for patients with ovarian carcinoma refractory to platinum based chemothrapy.
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Purpose:In order to deterimine the role of CK7 and other monoclonal antibodies in identification of primary and metastatic malignant ascites due to ovarian carcinoma.Methods:We used immunocytochemical ABC assay to detect the experssions of CK7、MG7、CEA、AB、CK、CK8、EMA、HBME、LCA、VIM monoclonal antibodies in 43 ascitic samples and 22 specimens. Chi square was used for statistic assay with SPSS 8.0 software. Results:One way ANOV assay showed that: (1) Cytokeratin 7 monoclonal antibody can be a very useful mark of primary ovarian carcinoma. (2) MG7 expression in peritoneal cells was significantly different in primary ovarian cancer and metastatic ovarian carcinoma of gastric origin. (3) CEA can be helpful in suggesting the origin of intestine carcinoma or not. (4) Immunohistochemical study of the peritoneal fluids showed results, similar to those in specimens. Conclusions: Immunocytochemical assay in the peritoneal fluids is a helpful diagnostic modality in differentiating between primary and metastatic ascites due to ovarian carcinoma.
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Purpose:To investigate the survival and prognostic factors in patients with stage Ib～IIb node-negative cervical carcinoma.Methods:From Nov.1993 to Dec. 1997,236 patients who had radical hysterectomy and pelvic lymphadenectomy and pelvic lymph node found negative were reviewed retrospectively. Survival rates were calculated by Kaplan-Meier method with differences in survival estimated by Log-rank test. Independent prognostic factors were identified by the Cox's proportional-hazards regression model. Results:The overall 5-year survival of the patients was 82.0% and the median survival time was 100.0 months. The recurrence and/or metastatic rate was 19.5%. Of these patients the 5-year survival rate was 16.9% and median survival time was 15.0 months. Among the variables,clinical stage(Ⅱb),tumor size(≥4 cm),histological type (non-squamous carcinoma),poor differentiation,deep stromal invasion,parametrial extension,vaginal margin involved,and lymphvascular permeation were the poor prognostic factors in univariate survival analysis ( P
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Objective To investigate individualized and multi-phase management of recurrent epithelial ovarian carcinoma in order to improve survival of the patients. Methods From 1998 to 2002, 70 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study. The treatments were divided into: (1) Induction of tumor remission:platinum sensitive patients were treated with paclitaxol + cisplatin (TP) or carboplatin + cyclophosphamide(CP)regimen; platinum resistant patients used Taxol + mitomycin(TM)or etoposide+ mitomycin(VM)regimen. Resection of tumors was done in an attempt to reduce the residual tumor with a diameter less than 1cm. Local radiotherapy was performed for those with residual tumor and who achieved clinical response after chemotherapy or surgery. (2) Consolidation therapy: chemotherapy with lower doses was administrated after disease remission. Interferon was used as immunotherapy during chemotherapy and radiotherapy. Survial analysis was done. Results (1) The 1, 2, 3, 4, 5-year survival rates were 67%, 51%, 45%, 38%, 32% . Median survival was 38.57 months. (3)The 1,2,3-year progression-free survival rates of the research arm were 41%, 37%, 24%. Median progression-free survival was 12.00 months. (4) Multivariate analysis revealed that platinum-free interval (P
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1 cm after secondary cytoreduction.
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6) of platinum based intravenous chemotherapy prolonged the survival of patients with suboptimal cytoreduction Intraperitoneal chemotherapy was one of the dominant long term survival determinants, and mainly on those with size of residual disease less than 1 cm
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Purpose:To detect the expression of cytokeratin 19 (CK19) mRNA and human papillomavirus type 16 (HPV16) mRNA in peripheral blood of cervical cancer patients. Methods:We used reverse transcription polymerase chain reaction (RT-PCR) to determine the expression of CK19 and HPV16 mRNA of 30 cervical cancer patients,8 patients with known distant metastases,16 patients with benign gynecological tumors and 9 healthy persons as control. Results:The presence of CK19 mRNA was observed in 3 peripheral blood samples among 30 cervical cancer patients (10%). The positive ratios for cervical patients with metastases,benign tumors and healthy control were 8/8,0/16 and 0/9. Only 10 cervical samples were proved to be HPV 16 positive by immunohistochemistry and/or hybridization in situ,whose expression of HPV16 mRNA in the peripheral blood were all negative (0/10). The positive ratios for cervical patients with metastasis,benign tumors and healthy control were 1/8,0/16 and 0/9,respectively. Conclusions:CK19 mRNA may be considered a powerful biomarker in the detection of peripheral blood of cervical cancer patients due to its high sensitivity and specificity. The detection of HPV16 mRNA was low and its clinical significance needs further evaluation.
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Purpose:To evaluate the significance of abdominal residue after primary cytoreductive su rgery for stage Ⅲ ovarian cancer.Methods:From Nov 1990 to Nov 1996, 57 patients with stage Ⅲ ovarian cancer who underwen t primary cytoreduction in our hospital and their residual disease were analyzed , with mean age of 51.9 (23～74). 20 patients achieved optimal cytoreduction (th e largest residual tumor ≤ 1cm). 9 patients had no gross residual tumor after s urgery, 37 cases had residual disease both in the abdomen and pelvis. Abdominal residual disease was found in 7 cases and pelvic residual disease in 4 cases. 30 cases were given chemotherapy before surgery. After primary surgery, 36 patient s received a mean of 3 courses of intraperitoneal chemotherapy and 46 patients were treated with a mean of 4 cycles of platinum-based intravenous chemotherapy . Complete remission were achieved in 32 cases (56.1%).Results:With a mean follow-up of 29.1 months (0.3～109.1months), 1-5 year survival rat es were 79.82%, 57.59%, 49.06%, 39.93%, 23.41%, respectively. Univariate analysi s indicated stage (P=0.0283), size of residual disease (P=0.0041), resid ue in the abdomen (P=0.0362), type of surgery (P=0.0337) and intraperito neal chemotherapy after surgery (P=0.0469) influenced survival. Multivariate analysis suggested that size of residual disease (P=0.0025), intraperiton eal chemotherapy (P=0.0323) and intravenous chemotherapy (P=0.0297)aft er surgery were independent prognostic factors of survival. Those patients who h ad no macroscopic residual lesion in the abdomen after cytoreducion had a better survival, with estimated median survival of 58.0 months vs 22.7 months for pati ents with abdominal residue (P=0.0362), with 3-year, 5-year survival rate of 83.64% vs 37.60% and 29.57% vs 21.05%, respectively. Residual disease in the pelvis did not affect the survival (P=0.2782). For patients with abdominal r esidue after surgery, optimal abdominal cytoreduction predicted increased surviv al (P=0.0319), while optimal pelvic cytoreduction predicted increased progre ss-free survival (P=0.0104). Stage(P=0.041), chemotherapy before surg ery(P=0.009)and pathologic classification(P=0.042)were determinants for abdominal residue after cytoreduction.Conclusions:The size of residual disease and abdominal residue after cytoreduction affected the progn osis for stage Ⅲ ovarian cancer. Patients with abdominal residue suffered a pes simistic outcome. Residual lesions in the abdomen influenced the patients' surv ival, while pelvic residue affected progress-free survival.