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Humans , Arm , Asian People , Bias , Carboplatin , Disease-Free Survival , Doxorubicin , Drug Therapy , Follow-Up Studies , Maintenance Chemotherapy , Ovarian Neoplasms , Prognosis , Quality of Life , Recombination, Genetic , Sample SizeABSTRACT
Objective To explore the clinical effect of neoadjuvant chemotherapy of endostar combined with docetaxel plus cisplatin(TP) on patients with advanced ovarian cancer.Methods 76 patients meeting the criterion were enrolled to the study,and they were randomly divided into study group and the control group.The control group were administered with TP,while the study group received endostar combined with TP.The clinical effects,conditions of surgery and long-term survival were observed.Results All patients finished 3 cycles of neoadjuvant chemotherapy.The incidence of adverse reactions (leucopenia,anorexia and fever) in the study group was higher than that in the control group,and the difference had statistical significance (P＜0.05).The level of CA125,tumor load and ascites volume decreased after chemotherapy (P＜0.05).The two groups had no significance difference in intraoperative ascites,blood loss,time of surgery or hospital stay (P＞0.05).The rate of residual lesion≤2 cm was 84.2％ in the study group,higher than that of the control group (60.5％),and the difference had statistical significance (P＜0.05).The overall 1-year and 3-year survival were 84.2％,and 63.1％ for the control group,86.8％ and 60.5％ for the study group,and the difference had no statistical significance (γ2=0.207,P=0.649).One-year and 3-year disease free survival were 89.4％ and 68.4％ for the control group,94.7％ and 76.3％ for the study group (γ2=4.042,P=0.040).Conclusion Endostar combined with TP (docetaxel plus cisplatin) for patients with advanced ovarian cancer is safe and effective,which can improve the success rate of cytoreductive surgery and local control rate of tumor.
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Objective To explore short term curative effects and adverse reactions of two different kinds of intraperitoneal hyperthermic chemotherapy (IPHC) drugs in the treatment of advanced ovarian cancer after cytoreductive surgery.Methods 76 patients with advanced ovarian cancer in the Second Affiliated Hospital of Zhengzhou University from July 2013 to November 2015 were divided into two groups:single-drugs group of 36 patients (IPHC with 5-fluorouracil after cytoreductive surgery combined with intravenous chemotherapy),combined treatment group of 40 patients(IPHC with 5-fluorouracil and carboplatin after cytoreductive surgery combined with intravenous chemotherapy).Short term curative effects,postoperative clinical indicators and adverse reactions of chemotherapy in two groups were compared and analyzed.Results The CA125 effective rates in single-drugs and combined treatment group were 86.11％ and 95％,and the difference showed statistically significant differences (P ＞ 0.05).The ascites remission rates in single-drugs and combined treatment group were 97.22％ and 97.5％,and the difference between two groups showed no statistically significant differences (P ＞ 0.05).Adverse drug reactions showed statistical difference in distribution of the bone marrow,liver damage and gastrointestinal toxicity.No statistical difference were found between the two groups in terms of distribution of renal damage and cardiovascular system damage.Conclusion IPHC after cytoreductive surgery in the treatment of advanced ovarian cancer is an effective means as adjuvant chemotherapy.The short-term curative effect of combined treatment group is obvious and adverse reactions can be tolerated.IPHC can be applied according to the patient's specific clinical situation.
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Objective To explore the effect of psychological intervention on patients with advanced ovarian cancer. Methods A total of 80 patients with advanced ovarian cancer patients combined with carboplatin or Western him paclitaxel combined with cisplatin in the treatment of patients, the implementation of grouping according to nursing, patients in the control group for routine care, patients in the observation group in the control group on the basis of psychological nursing. The two groups were observed and compared the clinical effect of intervention. Results The observation group the effective rate of the treatment and nursing satisfaction rate were significantly higher than the control group; the implementation of group nursing, observation group patients psychological status and improve the psychological status of patients in the observation group after treatment were better, and the control group have obvious difference. Conclusion For patients with advanced ovarian cancer chemotherapy, combined with psychological intervention on the basis of routine nursing, can significantly improve the treatment efficiency, improve the psychological status of patients, is worthy of clinical application
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Primary cytoreductive surgery followed by platinum-based chemotherapy represents the standard treatment for patients with advanced ovarian cancer.But some patients with advanced ovarian cancer still have suboptimal residual disease after the primary debulking surgery.Neoadjuvant chemotherapy has been suggested as an alternative strategy to achieve no residual disease.It is important to find methods to estimate the likelihood that cytoreductive surgery will leave no residual disease.A number of studies have evaluated the use of serologic markers (such as CA125),imaging modalities (such as CT,PETCT,MRI),and laparoscopic surgery to determine which patients are ideal predictors for neoadjuvant chemotherapy.As a new approach of assessment for preoperative evaluation regarding cytoreduction,laparoscopic surgery deserves further research.
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Objective To study the effects ofYiqi Huoxue Jiedu Recipe on immunomodulatory of patients with advanced ovarian cancer.Methods It was performed in a single-arm, open-label study with 40 patients with advanced epithelial ovarian cancer. All patients were treated withYiqi Huoxue Jiedu Recipe lasting for 4 weeks (200 mL, twice a day). The main endpoint was the quantities of CD4+CD25+ cells, CD8+CD28- regulatory T cells and CD8+CD28+ cytotoxic T cells measured by flow cytometry, and the accessory endpoints were variations of symptoms which included pain, fatigue, and numbness etc.Results The quantities of CD4+CD25+ and CD8+CD28- cells significantly decreased compared with those of pre-treatment (P<0.05); the quantity of CD8+CD28+ cell increased significantly (P<0.05). Except for pain, significant improvement showed in fatigue, tinnitus, numbness, poor appetite, abdominal discomfort, insomnia, diarrhea and abnormal urinate (P<0.05).ConclusionYiqi Huoxue JieduRecipe is proved to be effective in regulating immunosuppression advanced ovarian cancer and improving patients’ life quality.
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OBJECTIVE:To compare the efficacy,safety,vascular endothelial growth factor(VEGF)and matrix metallopro-teinase-2 (MMP-2) of docetaxel combined with carboplatin and paclitaxel combined with cisplatin (DDP) in the treatment of ad-vanced ovarian cancer. METHODS:120 patients with advanced ovarian cancer were randomly divided into docetaxel combined with carboplatin group(60 cases)and paclitaxel combined with DDP group(60 cases). Docetaxel combined with carboplatin group received 70 mg/m2 Docetaxel injection,intravenous infusion of 1 h,d1;50 mg/m2 carboplatin injection,intravenous infusion of 1 h,d2. Paclitaxel combined with DDP group received 135 mg/m2 Paclitaxel injection,intravenous infusion of 24 h,d1;30 mg/m2 DDP for injection,intravenous infusion,d3;60 mg/m2 Paclitaxel injection (a maximum of 2.0 m2) by intraperitoneal infusion,d8. 3-week was regarded as 1 treatment course,and it lasted 6 courses. Clinical efficacy,VEGF,MMP-2,progression-free survival, overall survival before and after treatment,mortality rate within 2 years of treatment and the incidence of adverse reactions in 2 groups were compared. RESULTS:There were no significant differences in the objective response rate,disease control rate,mortal-ity rate,incidence of adverse reactions between 2 groups(P>0.05). The progression-free survival in docetaxel combined with car-boplatin group was significantly longer than paclitaxel combined with DDP group,the difference was statistically significant (P0.05). After treat-ment,VEGF and MMP-2 level in 2 groups were significantly lower than before,and VEGF at different time points and MMP-2 level after 4 weeks,8 weeks and 12 weeks of treatment in docetaxel combined with carboplatin group were lower than paclitaxel combined with DDP group,the differences were statistically significant(P<0.05). CONCLUSIONS:Docetaxel combined with car-boplatin and paclitaxel combined with DDP shows similar efficacy and safety in the treatment of advanced ovarian cancer,but docetaxel carboplatin combined with is superior to paclitaxel combined with DDP in reducing VEGF and MMP-2 and improving pro-gression-free survival.
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Objective To investigatethe the clinical efifcacy and immunomodulatory effect of paclitaxel and cisplatin in treatment of advanced ovarian carcinoma by different administration ways. Methods 94 patients with advanced ovarian carcinoma were randomly divided into observation group and control group. Patients in observation group (47 cases) were treats with paclitaxel plus cisplation by intraperitoneal infusion chemotherapy, the other patients (47 cases) who are in control group were treats with paclitaxel plus cisplation by intravenous chemotherapy. Two groups used the same medicinal dose, and 3 weeks as a course. After two courses, therapeutic effect and drug toxicity side effects were evaluated by measuring positive rate changes of peripheral blood immune cells (CD 4+CD 25+cell), the CD 4+/CD 8+ratio changes, progression-free survival and 3-year survival rate. Results The efifcacy of patients in two groups were evaluated objectively. Observation group of RR and DC were respectively 78.7%and 91.5%, signiifcantly higher than that of control group. To the end of follow-up period, two groups of progression-free surial compared with a signiifcant difference. After two courses of chemotherapy, positive rate of immune cells (CD 4+CD 25+cell) declined had signiifcant difference compared with before treatment. After two courses of chemotherapy, two groups of CD 4+/CD 8+ratio were increased, compared with before treatment, which is a signiifcant difference. The main adverse reactions of the two groups were myelosuppression and neurotoxicity, but there were no termination of tolerance for adverse reactions. Conclusion The programs with paclitaxel plus cisplatin peritoneal perfusion chemotherapy for advanced ovarian cancer which is effective, small toxic and safe, is worthy of clinical application.
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Ovarian cancer is the highest death rate of gynecologic malignant tumor .Currently,people rec-ognize standard treatment for ovarian cancer was that reduction -Tumor cells of platinum based chemotherapy af-ter surgery.But for those patients who have developed into advanced cancer that cannot be operated the surgeries directly,the application of preoperative Neoadjuvant chemotherapy ( NACT) does have the superiority .which is recognized by the majority of clinical doctors ,and has been widely used in the treatment of advanced malignant tumor.It is worthy to discussing which part of patients should choose the initial treatment of Neoadjuvant chemo -therapy,rather than a direct treatment of destroying tumor cells .This article is summarizing the empirical cases based on related research ,in order to help clinicians to make a decision on the treatment of ovarian cancer .
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Objective:We aimed to investigate the clinical efficacy of neoadjuvant chemotherapy combined with cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP) after the operation of patients with advanced ovarian cancer. Meth-ods:Analysis of 60 patients with advanced ovarian cancer was performed at the Zhengzhou People's Hospital from April 2009 to July 2012. The patients were divided into two groups, namely, the research and control groups. The research group was treated with neoadju-vant chemotherapy combined with cytoreductive surgery and IHCP twice (cisplatin at 80 mg), and subsequently, with chemotherapy (TC/TP). The control group underwent primary cytoreductive surgery and chemotherapy (TC/TP). We compared the differences be-tween the two groups in terms of the following parameters:operation time, bleeding volume, volume of ascites, and postoperative che-motherapy. Results:The treatments in the research group were more efficient than those performed on the control group in terms of all the intraoperative indicators, and the difference between the two groups was statistically significant (P<0.05). Conclusion:Compared with conventional methods, the neoadjuvant chemotherapy combined with cytoreductive surgery and IHCP after operation was more ef-fective for patients with advanced ovarian cancer. Thus, neoadjuvant chemotherapy combined with cytoreductive surgery and IHCP af-ter operation can be applied in clinical settings.
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Objective:This study aimed to observe the curative effect and adverse reaction of docetaxel combined with intraperitoneal cisplatin chemotherapy and hyperthermia treatment of advanced ovarian cancer. Methods:A total of 83 patients with inoperable and recurrent advanced ovarian cancer were randomly divided into two groups:hyperthermia group and control group. The hyperthermia group consisted of 42 cases of docetaxel chemotherapy immediately treated with intraperitoneal cisplatin chemotherapy combined with abdominal local hyperthermia. The control group included 41 cases of docetaxel chemotherapy and intraperitoneal cisplatin chemotherapy treatment only. Results:The total efficiencies of the hyperthermia treatment group and the control group were 81%and 58.1%, respectively, which showed that the total efficiency significantly improved (P<0.05). The ascite control rates were 78.3%and 66.7%and CA125 decreased by 84.2%and 61.5%for the hyperthermia and control groups, respectively. The main adverse reactions were gastrointestinal reaction and bone marrow suppression. However, differences were not statistically significant. Conclusion:Docetaxel combined with cisplatin intraperitoneal perfusion hyperthermia significantly improved the curative effect on advanced ovarian cancer without increasing toxicity, which indicates that it is a treatment worth popularizing.
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Objetivo: Evaluar la experiencia con videotoracoscopía en pacientes con sospecha de cáncer de ovario avanzado con probable compromiso del tórax. Método: Se analiza las pacientes con sospecha clínica e imagenológica de cáncer de ovario avanzado que presentan derrames pleurales moderado y severo, así como procesos tumorales torácicos para evaluar la posibilidad de citorreducción óptima o completa. Todos los casos sometidos a este procedimiento entre enero de 2009 a Agosto de 2011, son analizados con énfasis en el diagnóstico y en los hallazgos a la videotoracoscopía, así como sus resultados. Resultados: 11 pacientes con clínica y tomografía axial computarizada de tórax sospechoso de compromiso pleural o pulmonar, son sometidas al procedimiento previo al intento de citorreducción abdominopélvica. La edad promedio fue de 62 años y Ca 125 promedio de 1030 U/ml. En 6 pacientes se encontró enfermedad macroscópica pleural, la biopsia fue positiva para adenocarcinoma en 5. Dos de ellas se consideraron no citorreducible en abdomen y se indicó neoadyuvancia. La tercera se citorredujo en forma óptima. En 2 pacientes se indicó neoadyudancia por tener residuo tumoral torácico mayor a 1 cm, consideradas citorreducibles en abdomen. De las 6 pacientes sin enfermedad torácica, 4 se citorredujeron óptimamente, una falleció previo a la cirugía abdominal y otra resultó un tumor ovárico benigno. Conclusión: La videotoracoscopía es útil para evaluar enfermedad torácica y tomar decisiones en relación a la citorreducción abdominal o neoadyuvancia en cáncer avanzado de ovario.
Objective: To describe the experience with video-assisted thoracic evaluation in patients with suspected advanced ovarian cancer with a probable thoracic involvement. Method: Patients with clinical and imaging suspicion of advanced ovarian cancer who have pleural effusions, and thoracic tumor processes are examined to evaluate the possibility of optimal debulking. All cases that underwent this procedure between January 2009 to August 2011, were studied with emphasis on diagnosis, results and findings at videotho-racoscopy. Results: 11 patients with a suspected thoracic commitment, with clinical and computerized axial tomography scan, undergo the procedure previous to an abdominopelvic cytoreductive surgery attempt. The average age was 62 years and CA 125 of 1030 U/ml average. Macroscopic pleural disease was found in 6 patients, but in 5 of them the biopsy gave positive for adenocarcinoma. Two of them were not considered for a cytoreductive surgery in the abdomen and neoadjuvant therapy was indicated. The third patient of the 5 previously mentioned, underwent an optimal cytoreduction. In 2 patients, neoadjuvant therapy was indicated for having residual tumor in the thorax greater than 1 cm, although they were considered for a cytoreductive surgery in the abdomen. Of the 6 patients without chest involvement, 4 underwent an optimal cytoreductive surgery, and one died before the abdominal surgery and the other had a benign ovarian tumor. Conclusion: Videothoracoscopy is useful for diagnosing thoracic metastasis and making decisions regarding cytoreduction and neoadjuvant therapy in advanced ovarian cancer.
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Humans , Female , Middle Aged , Thoracic Surgery, Video-Assisted/methods , Pleural Effusion, Malignant/pathology , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/pathology , Thoracic Neoplasms/secondary , Biopsy , Pleural Effusion, Malignant/diagnosis , Neoplasm Staging , Ovarian Neoplasms/surgery , Lung Neoplasms/secondary , Disease Progression , Thoracoscopy/methodsABSTRACT
OBJECTIVE: Neoadjuvant chemotherapy has been proposed as an alternative approach to conventional radical surgery with an aim to improve morbidity and survival. General acceptance of neoadjuvant chemotherapy as an alternative to primary surgery for patients who are not ideal surgical candidates remains controversial. The purpose of this study was to evaluate the efficacy of neoadjuvant chemotherapy in advanced epithelial ovarian cancer which are inadequate for primary optimal surgery. METHODS: A retrospective analysis of 18 patients was conducted to compare outcomes from December, 1995 to March, 2003. During the same period, 45 patients with advanced epithelial ovarian cancer received tumor debulking surgery followed by adjuvant chemotherapy. From this group, 18 patients were selected according to age, histologic types and FIGO stage. A comparison of both groups of patients was done. The operation records and pathologic reports were reviewed and CT/MRI images and pathologic slides were reevaluated. Last follow-up of medical records and phone-call were used to find out patient's status. SPSS 10.0 (SPSS Inc. Chicago, IL) was used to confirm a statistical significance. RESULTS: The optimal debulking (<2.0 cm) was possible in 14 cases (77.8%) compared to conventional therapy group in 8 cases (44.4%, p=0.040). The mean estimated blood loss was 620 cc (range 300-1500 cc) in neoadjuvant therapy group and 1061 cc (range 300-3500 cc) in conventional therapy group (p=0.040). Eight cases of optimal debulking relapsed (61.5%). The mean disease-free interval and overall survival of neoadjuvant therapy cases were 18.0 months and 48.3 months, respectively. The mean disease-free interval and overall survival of conventional therapy group were 23.9 months and 46.1 months respectively. There were no significant differences of disease-free survival and overall survival in two groups (p=0.482, p=0.605 respectively). CONCLUSION: Neoadjuvant chemotherapy provided higher rate of optimum cytoreduction and less amount of blood loss in patients with advanced epithelial ovarian cancer inadequate for primary optimum surgery. The results suggest that neoadjuvant chemotherapy results in survival rates that are comparable with those associated with primary cytoreductive surgery.
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Humans , Chemotherapy, Adjuvant , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Medical Records , Neoadjuvant Therapy , Ovarian Neoplasms , Retrospective Studies , Survival RateABSTRACT
Ovarian cancer has the highest mortality rate among gynecologic malignancies in developed countries. Most women present with advanced disease and require a combination of surgery and chemotherapy. One patient presented with recurrent ovarian cancer was initially treated with taxol and platinum-based compounds. Although response to these agents occurred, tumor progression was evident by elevated CA 125 levels and CT findings after a period of 4 months. This patient was then treated with topotecan and exhibited a response and stopped therapy. Topotecan exhibited activity in this patient with ovarian cancer resistent to both platinum and paclitaxel. We report a case of advanced ovarian cancer which was treated with topotecan after taxol-cisplatin treatment failed.