铂类药物敏感复发卵巢癌患者的三步化疗法附20例分析

Three-step chemotherapy treatment for platinum-sensitive recurrent ovarian cancer:a review of 20 cases

背景与目的:晚期卵巢癌患者治疗后80%会复发,中位无进展生存期(progression-free survival,PFS)为20个月。复发后的卵巢癌已不能治愈,只能延长生存期,改善生活质量。对铂类药物敏感首次复发的卵巢癌,设计三步化疗法,以期提高疗效。方法:2010年5月—2016年12月复旦大学附属肿瘤医院妇瘤科收治铂类药物敏感首次复发卵巢癌,经紫杉醇联合铂类药物化疗取得缓解者20例,患者均接受三步化疗法:(1)紫杉醇+卡铂,每3周给药1次,共6个周期;(2)奈达铂+依托泊苷+环磷酰胺,每4周给药1次,共5个周期,紫杉醇+卡铂,每4~6周给药1次,共4个周期;(3)奈达铂+依托泊苷+环磷酰胺,每8周给药1次,共5个周期。结果:20例患者4年无病生存率(disease-free survival,DFS)为65.0%(13/20),5年DFS为61.5%(8/13),4年、5年生存率均为100.0%(20/20,13/13)。结论:采用三步化疗法治疗铂类药物敏感复发卵巢癌,能提高疗效。三步化疗法疗效高,治疗费用较低,值得进一步临床研究。

Background and purpose:Over 80%of advanced ovarian cancer will recur after primary treatment with a median progression-free survival time of 20 months.Patients with recurrent ovarian cancer can’t be cured,but can achieve longer life span and improved life of quality.This study proposed to design a three-step chemotherapy regimen for firstly relapsed platinum-sensitive ovarian cancer to improve survival outcomes.Methods:From May 2010 to December 2016,20 patients with platinum-sensitive first relapsed ovarian cancer were treated in the Department of Gynecology and Oncology,Fudan University Shanghai Cancer Center.All patients received three-step chemotherapy.The three-step chemotherapy regimen included:①paclitaxel+carboplatin,administered once every 3 weeks,a total of 6 cycles;②nedaplatin+etoposide+cyclophosphamide,administered once every 4 weeks,total 5 cycles followed by paclitaxel+carboplatin,administered once every 4-6 weeks,a total of 4 cycles;③nedaplatin+etoposide+cyclophosphamide,administered once every 8 weeks,a total of 5 cycles.Results:The 4-year disease-free survival(DFS)rate and the 5-year DFS rate were 65.0%(13/20)and 61.5%(8/13),respectively.The 4-year and 5-year survival rates were both 100%(20/20 and 13/13).Conclusion:Three-step chemotherapy regimen is correlated to improved survival outcomes for patients with platinumsensitive recurrent ovarian cancer.Due to its promising effects and low costs,potential value of this treatment strategy is worth further exploration.