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Objective:To investigate the prognosis and influencing factors of secondary cytoreductive surgery (SCS) combined with chemotherapy in the treatment of recurrent ovarian cancer.Methods:A total of 102 patients with recurrent ovarian cancer admitted to our hospital from Jun. 2012 to Jun. 2015 were selected and grouped according to treatment methods. 31 patients who received paclitaxel/carboplatin (TC) chemotherapy were included in the control group, and 71 patients who received SCS combined with TC chemotherapy were included in the observation group. Clinical efficacy and 5-year survival outcome of the two groups after treatment, were compared and factors affecting the prognosis of the observation group were analyzed.Results:The total effective rate, 1-year survival rate, 3-year survival rate, and 5-year survival rate of the observation group were significantly higher than those of the control group. The median survival time of the observation group was 52 months and was significantly longer than that of the control group by 17 months ( P<0.05) ; There was no statistical difference between the death group and the survival group in terms of age, pathological type, tissue differentiation, recurrence tumor size, or location of recurrence tumors. The number of patients with FIGO stage IV, more than 3 recurrent tumors, ascites and residual lesion size >1 cm in the death group were significantly larger than those in the survival group. The serum CA125 level of patients in the death group was significantly higher than that in the survival group. Logistic regression analysis showed that the number of recurring tumors>3, with ascites, and residual lesions>1 cm, and high level of CA125 were independent risk factors for death after SCS combined with TC chemotherapy ( P<0.05) . Conclusions:SCS combined with chemotherapy can effectively improve the therapeutic effect, relieve the clinical symptoms, improve the survival rate of patients, and prolong the survival time of patients. The prognosis of SCS combined with chemotherapy is affected by the number of recurrent tumors, the presence or absence of ascites, the size of residual lesions, and CA125 level. The prognosis and survival of patients can be improved by adopting appropriate treatment.
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The high incidence and fatality rate of recurrent ovarian cancer (ROC) have always been the clinical problem. For part of patients with platinum-sensitive recurrent ovarian cancer, the secondary cytoreductive surgery (SCS) followed by platinum-based combination chemotherapy can prolong their survival time and improve quality of life. Therefore, it's a critical matter to accurately identify the patients who will benefit from surgery treatment. Several predictive models have been proposed for the selection of the patients for SCS. This article summarizes the research progress in the surgical treatment of platinum-sensitive recurrent ovarian cancer in recent years.
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Background: Rechallenge of a platinum-based chemotherapy is the most common approach for a recurrent platinumsensitive epithelial carcinoma ovary. However, this carries a substantial risk of cumulative neurotoxicity. Objectives: In the present study, we tried to compare the efficacy and toxicities of gemcitabine pegylated liposomal doxorubicin combination regimen to rechallenge of paclitaxel-carboplatin in this setting. Materials and Methods: A total of 30 patients were included in the study. The patients were randomized into two groups each containing 15 patients. The study group received injection gemcitabine at the dose of 1 g/m2 injection intravenously on day 1 and day 8 and liposomal doxorubicin 30 mg/m2 on day 1 in a 3 weekly cycle up to a total of six cycles in absence of disease progression or unacceptable toxicities. The control group patients were treated with injection paclitaxel at a dose of 175 mg/m2 I/V infusion and injection carboplatin at a dose considering area under the curve 6 in a 3 weekly for six cycles. Results: In the study arm, out of 14 patients, 4 (28.57%) patients had complete response, 6 (42.85%) had partial response, 3 (21.42%) had stable disease, and 1 (7.14%) showed disease progression. In the control arm, 6 (40%) patients out of 15 showed complete response, and 4 (26.66%) partial response. Disease progression was noted in 1 (6.66%) patient. There was less incidence of neurotoxicity compared to the control arm. Conclusion: Chemotherapy with a combination of gemcitabine and pegylated liposomal doxorubicin shows equivalent efficacy in platinum-sensitive recurrent ovarian cancer when compared to rechallenge of platinum-based chemotherapy. The regimen has an acceptable toxicity profile with lesser incidence of neuropathy than rechallenge of paclitaxel-carboplatin combination.
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Background & objectives: Advanced epithelial ovarian cancer (EOC) is associated with dismal outcome and progression-free survival (PFS) shortens with each subsequent relapse. For patients with recurrent and platinum refractory disease, therapeutic options are limited. Oral metronomic therapy (OMT) is associated with symptomatic relief and stable response in a significant proportion of patients. We retrospectively evaluated the outcome of patients with EOC treated with OMT at a tertiary care hospital in north India. Methods: Between January 2011 to December 2017, 36 EOC patients received OMT. Patients' median age was 50 yr (range, 38-81 yr) and they had received a median of two lines of prior chemotherapy. OMT regimen included a combination of cyclophosphamide, etoposide (VP-16) and celecoxib with or without pazopanib along with supportive care. Response rates and outcomes were ascertained using the Gynecological Cancer Intergroup Guidelines. The toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03. Results: The median CA-125 before initiating OMT was 160 U/ml (range, 42.23-5330 U/ml). The median interval between last chemotherapy and starting OMT regimen was 159 days (range, 1-1211 days). The overall response rate was 50 per cent. The median progression-free survival (PFS) was 8.2 months [95% confidence interval (CI): 5.03-10.33], and the median overall survival was 38 months (95% CI: 25.6-NR). Patients who received two lines of chemotherapy before OMT (P=0.052) and those who received pazopanib-based OMT (P=0.0513) had better PFS. Interpretation & conclusions: For patients with relapse and refractory EOC, OMT could be a reasonable option. A combination of oral etoposide (VP-16) and pazopanib needs further evaluation in a large number of patients in a randomized trial.
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Objective To explore the efficacy and safety of Bevacizumab combined with albumin binding paclitaxel in the treatment of platinum resistant recurrent ovarian cancer.Methods From June 2014 to January 2016,eighty-two recurrent ovarian cancer patients were selected in the study and randomly divided into the treatment group (41 cases) and the control group (41 cases),the control group was treated with albumin binding paclitaxel,and the treatment group was treated with Bevacizumab combined with albumin binding paclitaxel.The clinical efficacy (such as overall response rate,complete response rate,partial response rate,stability of disease,progression of disease),progression free survival (PFS),overall survival (OS) and the adverse reaction rate were compared.Results The total effective rate (ORR) of the experimental group was 85.37％ (35/41),which was significantly higher than that of the control group (65.85％ (27/41),and the difference was statistically significant (P=0.040).The median PFS and OS in the experimental group were 9 (1 ～16) months and 16 (4～26) months,significantly higher than those in the control group (6 (1 ～ 13)months (HR =0.624,95％ CI:0.367 ～ 0.899,P =0.023);12 (2 ～ 25) months (HR =0.603,95％ CI:0.324 ～ 0.791,P =0.009);subgroup analysis showed that the median OS of patienta without metastasis in the experimental and control group were 18 (8 ～ 26) months and 13 (2 ～ 25) months respectively (HR =HR =0.610,95％ CI:0.229 ～ 1.544,P=0.291),and the median PFS was 11 (5～ 16) months and 8 (1 ～ 13) months (HR=0.496,95％CI:0.160～1.046,P=0.089),there were no significant differences;the median P FS in patients with metastasis of the experimental group and the control group were 9 (3～14)months and 6 (1～ 10)months (HR =0.483,95％ CI:0.273 ～ 0.769 months,P＜0.001),the median OS were 14 (4～22) months and 11 (2～20)months (HR =0.556,95％CI:0.197～ 0.569,P=0.008).There was no significant difference in the incidence of adverse reactions between the two groups (12.20％,21.95％,P=0.240).Conclusion Compared with the treatment of albumin binding paclitaxel,in the treatment of platinum resistant recurrent ovarian cancer,the combined treatment of bevacizumab and albumin binding paclitaxel can significantly improve the clinical effect and improve the patients' survival and total survival time.
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Objective To explore the effect of targeted nursing intervention on the psychological status of patients with recurrent ovarian cancer,so as to provide a reliable basis for improving the clinical nursing work of recurrent ovarian cancer. Methods A total of 60 cases of recurrent ovarian cancer treated in our hospital from January 2016 to March 2017 were selected as the research objects,and they were randomly divided into the observation group and the control group with 30 cases in each group.The observation group received targeted nursing intervention,while the control group received routine nursing care.Observation and comparison of two groups of patients before and after nursing intervention anxiety, pain threshold changes,as well as the satisfaction of nursing services. Results Self-rating Anxiety Scale (SAS)scores after the intervention in the observation group was(40.13 ± 5.73)points,the control group was (51.12 ± 3.98)points,the difference was statistically significant(t=6.145,P=0.011).Observation group and control group before the intervention Visual Analogue Scale(VAS)score was(5.03 ± 1.22)points,(5.23 ± 1.38)points,there was relatively no significant difference(t=1.236,P=0.384)between the two groups;VAS scores after the intervention of the observation group was(1.13 ± 0.83)points,the control group was(2.52 ± 1.24) points,the observation group was significantly lower than the control group, the difference was significant(t=3.047,P=0.032).The observation group of patients for overall satisfaction of nurses was 80.00% (24/30),the control group of patients overall satisfaction was 43.33% (13/30) for nurses, overall satisfaction among groups observation group was significantly higher overall satisfaction(χ2=4.842,P=0.021). Conclusions Compared with routine nursing, targeted nursing intervention can significantly improve the anxiety and pain threshold of patients with recurrent ovarian cancer, improve nursing satisfaction,and can be popularized and applied in clinic.
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OBJECTIVE:To compared with empirical medication and medication under the guidance of adenosine triphos-phate-tumor chemosensitivity assay (ATP-TCA) in the treatment of platinum resistance recurrent ovarian cancer,and to explore clinical efficacy,survival situation of the occurrence of ADR. METHODS:90 cases of platinum resistant recurrent ovarian cancer were divided into drug sensitive group(46 cases)and control group(44 cases)according to admission order. According to clinical experience,control group was given gemcitabine+ifosfamide+doxorubicin for chemotherapy;according to the ATP-TCA test re-sults,chemotherapy plan of drug sensitive group was determined. A treatment course of 2 groups lasted for 28 d,and both received 2-6 courses of chemotherapy. Chemotherapy efficacy,survival situation and the occurrence of ADR were compared between 2 groups. RESULTS:18 cases receiving paclitaxel,14 cases receiving doxorubicin,6 cases paclitaxe+vinorelbine,5 cases gemcitabi-ne,3 cases topotecan in the drug sensitive group. The total effective rate of drug sensitive group was 58.70%,which was signifi-cantly higher than that(36.96%)of control group,with statistical significance(P0.05). CONCLUSIONS:According to ATP-TCA test results,chemotherapy efficacy and survival situation of patients with platinum resistant recurrent ovarian cancer receiving targeted chemotherapy regimen are better than those receiving clinical empirical medication,and the incidence of ADR will not be influ-enced.
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Objective:To evaluate the safety and efficacy of a palliative regimen of computed tomography (CT)-guided 125I seed im-plantation combined with chemotherapy for recurrent ovarian cancer. Methods:A total of 21 patients with recurrent ovarian cancer, who received 125I seed implantation and chemotherapy, were retrospectively analyzed. Out of the 29 lesions detected, 25 lesions were suitable for 125I seed implantation. Treatment planning system (TPS) was implemented preoperatively to determine the number and dis-tribution of 125I seeds. Under CT guidance, 125I seeds were implanted into the recurrent lesions using the TPS. Within 3 d of 125I seed im-plantation, liposomal paclitaxel was administered by intravenous infusion on day 1 and carboplatin by infusion via the feeding artery of tumor on day 2. Chemotherapy was repeated on a 21-day schedule. Efficacy and complications were evaluated during follow-up. Re-sults:After two cycles of chemotherapy, out of the 25 recurrent lesions that underwent 125I seed implantation, four lesions showed com-plete remission, 14 with partial remission, three with stable disease, and four with progression of disease. The objective response rate was 72%, and the pain relief rate was 82.4%. Karnofsky's performance status scores increased dramatically (P=0.019). The median pro-gression-free survival time was 6.8 months, median overall survival time was 14.2 months, and the 1-year survival rate was 42.9%. He-matologic toxicity and gastrointestinal reactions were the primary adverse conditions. No severe radiation complications and treat-ment-related deaths were observed in all patients. Conclusion:CT-guided 125I seed implantation combined with chemotherapy is active and well-tolerated in patients with recurrent ovarian cancer. This combined treatment cannot only significantly enhance the objective re-sponse rate, but also leads to remarkable improvement in cancer-related symptoms.
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BACKGROUND: Bevacizumab, a recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor A, was described to be effective in the treatment of recurrent or platinum‑resistance ovarian cancer. The present retrospective study was performed to further evaluate the clinical efficacy and toxicity of bevacizumab in the treatment of Chinese recurrent ovarian cancer patients who had been previously treated by platinum‑based chemotherapy. MATERIALS AND METHODS: We reviewed the hospital database and finally included 26 recurrent ovarian cancer patients who were treated with bevacizumab combined with gemcibabine or paclitaxel or single agent. All included patients received >3 cycle of bevacizumab treatment. The tumor response, overall survival, and toxicities were documented. RESULTS: Under the treatment of bevacizumab combined with gemcibabine or paclitaxel, 2 complete response (7.7%), 8 partial response (30.8%), 7 stable disease (26.9%) and 9 progression disease (34.6%) was documented with the objective response rate of 38.5% and disease control rate of 65.4%. The median overall survival from the first application of bevacizumab was 15.3 months [Figure 1] for all of the 26 patients. The median overall survival time was 16.2 and 14.0 months for bevacizumab + gemcitabine and bevacizumab + paclitaxel treatment schedule respectively. The overall survival was not different between bevacizumab + gemcitabine and bevacizumab + paclitaxel treatment regimen hazard ratio = 0.80 (95% confidence interval: 0.32–2, P = 0.64). The hypertension and proteinuria were the major bevacizumab related toxicities. CONCLUSIONS: Bevacizumab combined with gemcibabine or paclitaxel was a promising treatment schedule for platinum‑resistance recurrent ovarian cancer.
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OBJECTIVE: This study was conducted to examine the effects of front-line chemotherapy on overall survival (OS) and postrecurrence survival (PRS) of patients with recurrent ovarian cancer, when stratifying the histologic type. METHODS: Five hundred and seventy-four patients with recurrent ovarian cancer with sufficient clinical information, including front-line chemotherapy, were analyzed. The pathologic slides were evaluated by central pathologic review. The patients were divided into two groups: group A (n=261), who underwent taxane plus platinum, and group B (n=313), who underwent conventional platinum-based chemotherapy without taxanes. RESULTS: The median age was 54 years (range, 14 to 89 years). Group A had significantly better median OS (45.0 months vs. 30.3 months, p<0.001) and PRS (23.0 months vs. 13.0 months, p<0.001) compared to group B. The OS and PRS were similar between the groups in patients with clear cell or mucinous histology. In contrast, among patients with non-clear cell, non-mucinous histologies, the OS and PRS of group A were significantly better than those of group B (OS, p<0.001; PRS, p<0.001). Multivariable analyses revealed that, among patients with non-clear cell, non-mucinous histologies, chemotherapy including taxane and platinum was an independent predictor of favorable survival outcomes. Conversely, in patients with clear cell or mucinous histology, taxane-including platinum-based combination chemotherapy did not improve the OS and PRS compared to a conventional platinum-based regimen which did not include taxanes. CONCLUSION: Since the emergence of taxane plus platinum, the prognosis of patients with recurrent ovarian cancer has improved. However, we here demonstrate that this improvement is limited to patients with non-clear cell, non-mucinous histologies.
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Humans , Drug Therapy , Drug Therapy, Combination , Mucins , Ovarian Neoplasms , Platinum , Prognosis , TaxoidsABSTRACT
In patients with gynecologic malignancies, bone metastases are unusual and generally occur in a more advanced stage of the disease with extended local invasion of the primary site and/or parenchymal metastasis. In ovarian cancer, the main route of spread is intraperitoneal implantation and loco-regional invasion, whereas extraperitoneal spread usually implies advanced disease. Bone metastasis from ovarian cancer is rare and occurs in approximately 1% of primary or recurrent disease. The prognosis of cases with bone metastasis is poor. We report a patient with metastases to the sternum and a rib after prolonged treatment and a patient with recurrent ovarian cancer metastatic to the sacrum 8 months after primary treatment.
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Humans , Neoplasm Metastasis , Ovarian Neoplasms , Prognosis , Ribs , Sacrum , SternumABSTRACT
OBJECTIVE: The objective of this study was to identify the prognostic factors of secondary cytoreductive surgery on survival in patients with recurrent epithelial ovarian cancer. METHODS: The medical records of all patients who underwent secondary cytoreductive surgery between May 2001 and October 2007 at the National Cancer Center, Korea were reviewed. Univariate and multivariate analyses were executed to evaluate the potential variables for overall survival. RESULTS: In total, 54 patients met the inclusion criteria. Optimal cytoreduction to or =12 months vs. 24 months for PFS or =12 months. Secondary cytoreductive surgery should be offered in selected patients and large prospective studies are needed to define the selection criteria for secondary cytoreductive surgery.
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Humans , Disease-Free Survival , Korea , Medical Records , Multivariate Analysis , Neoplasms, Glandular and Epithelial , Ovarian Neoplasms , Patient Selection , Pelvis , RecurrenceABSTRACT
OBJECTIVE: The aim of this study was to evaluate the efficacy and toxicity of topotecan, camptothecin analogue topoisomerase I inhibitor, as the combination therapy with platinum in patients with recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis. METHOD: In this study, patients who were treated with topotecan between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Fifty-one patients with recurrent ovarian carcinoma and peritoneal carcinomatosis were included. These patients' data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria for patients with measurable disease and CA-125 response criteria for patients with non-measurable disease. The toxicities were evaluated according to NCI CTC (Common Toxicity Criteria) version 3.0. RESULTS: The mean age of patients was 53.4 years (ranged between 37 and 69). Forty-four patients had been evaluated by RECIST criteria. The overall response rate was 22.8% (10/44). Platinum-sensitive patients showed more favorable response rate (26.9%) than platinum-resistant patients (16.7%), however, it was not significant statistically (p=0.425). Platinum-sensitive group had significantly longer response duration (12.14 vs. 3.33 months, p=0.022) and time-to-progression (11.34 vs. 7.33 months, p=0.042) than platinum-resistant group. Heavily pretreated group, three or more prior regimens were used, had no significant differences from another group. The most common adverse effect of topotecan in combination with platinum was hematologic toxicity; grade 3/4 neutropenia was 30.6%, anemia was 42.7%, and thrombocytopenia was 8.37% in total 265 cycles of chemotherapy, however, it was tolerable. CONCLUSION: Topotecan in combination with platinum is considered as effective regimen with acceptable toxicity in treating recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis who have failed previous treatment with platinum-containing chemotherapy.
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Humans , Anemia , Camptothecin , Carcinoma , DNA Topoisomerases, Type I , Korea , Medical Records , Neoplasms, Glandular and Epithelial , Neutropenia , Ovarian Neoplasms , Platinum , Retrospective Studies , Thrombocytopenia , TopotecanABSTRACT
OBJECTIVE: We evaluated the effects and toxicities and cost effectiveness of iv etoposide-carboplatin- cyclophosphamide (ECC) combination chemotherapy against persistent or recurrent ovarian cancer who were previously heavily treated with one or more lines of chemotherapy which included platinum-paclitaxel- cyclophosphamide-topotecan based regimens. METHODS: Fifteen patients with a persistent or recurrent ovarian cancer, previously received first or more line chemotherapy, had been treated with ECC combination chemotherapy at Konsin Medical Center from September 2000 to October 2002. The ECC (iv etoposide-carboplatin-cyclophosphamide) combination chemotherapy consists of 100 mg/m2 etoposide iv and 500 mg/m2 cyclophosphamide iv in first day and 100 mg/m2 etoposide iv, 450 mg/m2 carboplatin iv in second day and 100 mg/m2 etoposide iv in third (and 4th-5th day if necessary) every 3-4 weeks. The response of patients was evaluated with the tumor marker (serum CA-125) and imaging studies (ultrasonogram, CT, MRI). The toxicities were defined according to the WHO toxicity criteria. RESULTS: The overall response rate by WHO criteria is 47%. In detail, partial response is 47%, Stable disease is 40% and progressive disease is 13%. The serologic CA-125 response rate is 64%, in detail serologic partial response is 64%, and serologic stable disease is 22% and serologic progressive disease is 14%. The median response duration is 9 months (4 to 12 months), the median time to response is 1 month (2 weeks to 2 months) and the median time to progression is 9 month (4 to 12 months). The most common side effect is nausea and vomiting and the bone marrow suppression is proved as a most serious side effect (grade 3 or more-13%). CONCLUSION: The iv etoposide-carboplatin-cyclophosphamide chemotherapy as a 2nd or more lines regimen against persistent or recurrent ovarian cancer is considerable.
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Humans , Bone Marrow , Carboplatin , Cost-Benefit Analysis , Cyclophosphamide , Drug Therapy , Drug Therapy, Combination , Etoposide , Nausea , Ovarian Neoplasms , VomitingABSTRACT
OBJECTIVE: To evaluate the efficacy and side effects of cispaltin and carboplatin each in combination with paclitaxel in recurrent epithelial ovarian cancer who had not taken paclitaxel-based chemotherapy. MATERIALS AND METHODS: Between January 1994 and October 1999, in department of obstetrics and gynecology, Asan medical Center, 42 recurrent ovarian cancer patients who had initial platinum-based chemotherapy except paclitaxel were treated with paclitaxel-based chemotherapy. One group was 14 patients treated with paclitaxel-cisplatin and the other group was 28 patients treated with paclitaxel-carboplatin. Disease free interval before recurrence was 6 months at least. Patients received paclitaxel 135mg/m2 followed by either cisplatin 75mg/m2 or carboplatin 300mg/m2. The schedule was repeated every 3 weeks for at least 6 cycle. Response was evaluated by physical examination, serial serum CA 125 measurement, chest PA before each cycle, and abdomino-pelvic CT scan every 3 cycles. RESULTS: As paclitaxel-cisplaitin group, with a median follow-up of 34.5 months (range, 9-60 months), 1 patient had complete response, 6 patients had partial response, 3 patients had stable disease and 4 patients had persistent disease, overall response rate was 50%, mean survival duration was 40 months. As paclitaxel-carboplatin group, with a median follow-up of 25.5 months (7-36 months), 4 patients had complete response, 11 patients had partial response, 6 patients had stable disease, and 7 patients had persistent disease, overall response rate was 53.4%, mean survival of 24 months. As grade of side effects in each group, we evaluated leukopenia, anemia, thrombocytopenia, nausea, vomiting, fever, neurological abnormality, and renal abnormality. The rate of grade 3 to 4 leukopenia was 11% in paclitaxel-cisplatin arm and 17% paclitaxel-arboplatin, in arm. CONCLUSION: These results demonstrate that the combined chemotherapy of paclitaxel followed by cisplatin or carboplatin is highly effective and safe in recurrent epithelial ovarian cancer who had taken no previous paclitaxel-based chemotherapy.