Clinical significance of CA125 regression in chemotherapy of advanced ovarian cancer

Objective:The aim of this study was to compare the serum CA125 regression in advanced ovarian carcinoma patients treated with paclitaxel/platinum (TP) and platinum/epirubicin/ifosfamide (PAC) during early chemotherapy.The relationship between survival and CA125 regression during first line chemotherapy was evaluated.Methods:This retrospective investigation assessed 122 and 95 patients with stages IIc-IV ovarian carcinoma who underwent initial surgery followed by TP or PAC chemotherapy,respectively.Only epithelial ovarian cancers were included.CA125 half-life was calculated by mono-compartmental logarithmic regression.Every patient's nadir CA125 concentration was also studied.T-test was used in comparing CA125 half-life and nadir CA125 between two groups.Survival analyses for progression-free survival (PFS) and overall survival (OS) used univariate (Kaplan-Meier) and multivariate (Cox) models for all of the patients.Results:There was not significant difference in CA125 half-life and nadir CA125 concentration between two groups (P > 0.05).CA125 half-life and nadir CA125 concentration had a univariate prognostic value for PFS and OS (P < 0.0001) in all of the patients.However pre-chemotherapy CA125 and different chemotherapy agents were not prognostic factors for PFS and for OS (P > 0.05,for each).In Cox models,CA125 half-life (P=0.0006),residual tumour (P < 0.0001),and nadir concentration (P=0.0032) were significant prognostic factors for disease free survival (DFS).For OS,CA125 half-life (P=0.0013),residual tumor (P < 0.0001),and nadir concentration (P=0.0118) were also the significant prognostic factors.Conclusion:There isn't significant difference in serum CA125 regression between patients who are treated with PAC or PT during early chemotherapy.CA125 half-life and nadir CA125 concentration are independent prognostic factor in advanced ovarian cancer.

Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study

This article provides a brief description of an epithelial ovarian cancer （EOC） case （stage Ⅳ） treated with the association of complete CytoReductive Surgery and hy-pertermic intraPEritoneal chemotherapy （HIPEC）. The use of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treat-ment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since defnitive cure is unlikely. We reviewed the entire decision making process considering the risk/beneft of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization-International Classification of Function-ing, Disability and Health that permits evaluation of the person in relation to the psycho-social context is pre-sented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survi-vors are of central importance for decision making.

Effect of Bevacizumab Combined with Neoadjuvant Chemotherapy in Advanced Ovarian Cancer and the Occurrence of Adverse Reactions

Objective:To explore the effect of bevacizumab combined with neoadjuvant chemotherapy in advanced ovarian cancer and the occurrence of adverse reactions.Methods:A total of 80 patients with advanced ovarian cancer,treated in Affiliated People's Hospital of Inner Mongolia Medical University from June 2019 to December 2020,were randomly divided into two groups.In the chemotherapy group,40 patients were treated with neoadjuvant chemotherapy,while in the combined group,another 40 patients were treated with bevacizumab combined with neoadjuvant chemotherapy.The therapeutic effects were compared at the end of the treatment cycle.Results:There was no significant difference in the levels of CA125,CEA,and VEGF between the two groups before treatment.However,after the treatment cycle,the levels of CA125,CEA,and VEGF in the combined group were significantly better than those in the chemotherapy group(P<0.05).At the same time,the incidence of adverse reactions of the chemotherapy group was 67.50%,which was significantly higher than that of the combined group(35.00%;P<0.05).Conclusion:Bevacizumab combined with neoadjuvant chemotherapy for patients with advanced ovarian cancer has significant curative effect.The combined therapy reduces the levels of tumor markers and inflammatory factors,improves patients'quality of life,as well as reduces adverse reactions.It has high clinical promotion value.

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Objectives： To compare the survival and perioperafive morbidity between primary debulking surgery （PDS） and neoadjuvant chemotherapy followed by interval debulking surgery （NAC/IDS） in treating patients with advanced epithelial ovarian cancer （EOC）. Methods： We retrospectively reviewed 67 patients with stage IIIC or iV EOC treated at Peking University Cancer Hospital from January 2006 to June 2009. VVherein, 37 and 30 patients underwent PDS and NAC/ IDS, respectively. Results： No difference in overall survival （OS） or progression-free survival （PFS） was observed between NAC/IDS group and PDS group （OS： 41.2 vs. 39.1 months, P=0.23; PFS： 27.1 vs. 24.3 months, P=0.37）. The optimal debulking rate was 60% in the NAC/IDS group, which was significantly higher than that in the PDS group （32.4%） （P=0.024）. The NAC/IDS group had significantly less intraoperative estimated blood loss and transfusion, lower nasogastric intubation rate, and earlier ambulation and recovery of intestinal function than the PDS group （P〈0.05）. Conclusions： NAC/IDS is less invasive than PDS, and offers the advantages regarding optimal cytoreduction rate, intraoperative blood loss, and postoperative recovery, without significantly impairing the survival compared with PDS in treating patients with stage IIIC or IV EOC. Therefore, NAC/IDS may be a valuable treatment alternative for EOC patients.

Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients

Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.

Taking Care of Her: A Pilot Feasibility Study of a Caregiver Intervention for Women with Advanced Stage Ovarian Cancer

The purpose of this study is to examine the feasibility and short-term impact of a fully manualized, telephone-delivered intervention for spouse caregivers, Taking Care of Her (TCH). A total of 12 study participants from the Pacific NW were enrolled whose wife was diagnosed with Stage III ovarian cancer within 8 months. Feasibility was confirmed by rates of recruitment and retention;the quality of delivery of the intervention by telephone;and through data obtained on program acceptability during follow up exit interviews. Outcomes from the within-group analysis revealed improvements on standardized measures of spouses’ and patients’ depressed mood and anxiety;marital communication about the cancer;caregivers’ skills and confidence to manage the emotional toll of the illness on themselves and wives;and wives’ positive appraisal of spousal support. Study results suggest that the TCH Program has the potential to positively affect both spouse caregiver and patients’ adjustment to recently diagnosed advanced ovarian cancer. Telephone delivery holds promise for sustainability. A future clinical trial with a larger study sample is warranted.

Effects of CMNa combined with paclitaxel and carboplatin on elevated CA125 levels in post-operation advanced ovarian cancer patients

Objective： To investigate the effects of CMNa combined with paclitaxel and carboplatin on elevated CA125 levels in post-operation advanced ovarian cancer patients. Methods： The effects of CMNa combined with paclitaxel and carboplatin on elevated CA125 levels in 25 post-operation advanced ovarian cancer patients were retrospectively analyzed and com- pared with those in 20 control cases. Results： After 1 cycle of chemotherapy, CA125 levels had decreasing trend compared with control, but had no statistical significance. While after two cycles of chemotherapy, CA125 levels decreased more rapidly compared with those in control. Side effects in two groups were alike. Conclusion： CMNa combined with paclitaxel and car- boplaline has a stronger effect on the decrease of elevated CA125 levels than paclitaxel and carboplatin have in the treatment of post-operation advanced ovarian cancer, which indicates that CMNa has chemo-sensitizing effects on chemotherapy of paclitaxel and carboplatin.

Cytoreductive surgery in primary advanced epithelial ovarian cancer

Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients(about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy(CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease(RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefi t of surgery. It's still undefi ned how the intrinsic features of the tumor make intra-abdominal implants easier to remove.Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the defi nition of RD is not universal. A unique and defi nitive defi nition is needed.

A retrospective clinical study of neoadjuvant chemotherapy for advanced epithelial ovarian cancer

Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy(NACT) and the prognostic factors for advanced epithelial ovarian cancer(EOC).Methods We enrolled 241 patients with stage III and IV EOC who were diagnosed at the Yunnan Cancer Hospital between October 2006 and December 2015.The observation(NACT-IDS) group(n = 119) received 1–3 courses of platinum-based NACT,followed by interval debulking surgery(IDS) and 6–8 courses of postoperative chemotherapy.The control group underwent primary debulking surgery(PDS)(n = 122) followed by 6–8 courses of postoperative chemotherapy.We analyzed the general conditions of the operations and the survival of both groups.Results Operating time,intraoperative blood loss and postoperative hospitalization were significantly lower in the NACT-IDS group(P < 0.05).The rate of optimal cytoreductive surgery was significantly higher in the NACT-IDS group(P < 0.05).A visible residual lesion was observed in 49(41.18%) and 48(40%) cases in the NACT-IDS and PDS groups,respectively,which were not significantly different(P > 0.05).The percentage of International Federation of Gynecology and Obstetrics(FIGO) stage IV tumors and the recurrence rates were significantly higher in the NACT-IDS group(P < 0.05).The mortality rates were 45.19%(47/104) and 35.19%(38/108) in the NACT-IDS and PDS groups,respectively(P > 0.05).Progression-free survival was 23.75 ± 9.98 and 23.57 ± 12.25 months in the NACT-IDS and PDS groups,respectively(P > 0.05).Overall survival(OS) was 31.11 ± 15.66 and 29.63 ± 18.00 months in the NACTIDS and PDS groups,respectively(P > 0.05).Optimal cytoreductive surgery with or without residual lesion was an independent influencing factor for advanced EOC in multivariate analysis.OS of patients treated with ≥8 courses of chemotherapy was significantly longer than those treated with < 8 courses.Conclusion NACT could improve the intra-and postoperative conditions in advanced EOC patients.Although the percentage of FIGO stage IV cancer was significantly higher in the NACT-IDS group,the prognosis was similar in both the NACT-IDS and PDS groups,suggesting that NACT improves the clinical outcome of advanced EOC.Optimal cytoreductive surgery with no residual lesion is a long-term protective factor in advanced EOC.At least 8 courses of chemotherapy overall or ≥ 6 courses postoperatively improves the OS.

Comparative Study on Three Chemotherapeutic Regimens for the Treat-ment of Advanced Epithelial Ovarian Cancer

To investigate the best first-line chemotherapy regimen for the treatment of advanced ep- ithelial ovarian cancer (AEOC), the efficacy of three chemotherapy regimens for treatment of the pa- tients with AEOC in our hospital during Jan. 1992- Jan. 1999 was retrospectively analyzed. The therapeutic effects were compared with the supplement of Melphalan + Hexamethylme (PAM + HMM), cisplatin+ adriamycin+cyclophosphamide or isofamide (PAC) or cisplatin+cyclophospha- mide or isofamide (PC), Taxol+cisplatin (TP) combined chemotherapy after cytoreductive surgery. The results showed that the overall effective rate of TP was significantly higher than that of PAM+ HMM (P<0. 05); The complete remission rate of TP was significantly higher than that of PAM+ HMM and PAC or PC (all P<0. 05); The 2-year survival rate free of tumor of TP was obviously higher than that of PAM+HMM and PAC or PC(all P<0. 05). It was concluded that the therapeu- tic effect of TP regimen in the treatment of AEOC was better than PAM+HMM and PAC or PC and TP regimen could be recommended currently as the preferred first-line one for the treatment of AEOC.

Prognostic factors for survival after neoadjuvant chemotherapy for advanced ovarian cancer: meta-analysis

Background: In advanced disease current practice is staging and primary debulking laparotomy followed by platinum-based chemotherapy. The effort to achieve ‘optimal debulking’ is associated with a complication risk of 8% - 63% and a mortality rate of 1% - 6%. Neoadjuvant chemotherapy has been proposed as an alternative option. Objectives: This meta-analysis aimed to determine prognostic factors influencing survival in patients with advanced ovarian cancer following neoadjuvant chemotherapy. Search Strategy: Clinical trials citing the terms ‘advanced ovarian cancer’, ‘ovarian cancer’, ‘neoadjuvant chemotherapy’ and ‘surgery’ were identified by searching Pubmed and ScienceDirect between January 1st 2000 and September 30th 2010. Data Collection and analysis: The trials included used platinum-based chemotherapy and involved stage III/IV disease that underwent neoadjuvant chemotherapy followed by surgery. Prognostic variables were identified for analysis including number/type of chemotherapy, % stage IV disease, % maximal cytoreductive surgery and whether a lymphadenectomy was performed. The % bowel surgery and ultra-radical surgery was also analysed. Main Results: Twenty six trials were identified as suitable for analysis and included 3 non-randomised Phase II studies, 2 retrospective case-control studies, 17 from retrospective analysis and 1 RCT. A significant association between taxane use vs platinum only (p = 0.019), year of publication (p = 0.032), % maximal interval cytoreduction (p = 0.046) and median overall survival was identified. No significant survival benefit was demonstrated with number of chemotherapy cycles (p = 0.065), lymphadenectomy (p = 0.813) and % bowel surgery performed (p = 0.606). Conclusions: The addition of taxane and % maximal cytoreduction achieved is associated with improved overall survival. There is, however no evidence that lymphadenectomy, number of chemotherapy cycles or bowel surgery influences survival.

Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer

Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of complete resection with no residual tumor, less post-operative surgical morbidity and significant increase progression-free survival and overall survival. Both responses to NACT and residual tumor volume were the two independent prognostic factors for survival in ovarian cancer.

The Administration of Ocoxin Increases the Quality of Life of Patients with Advanced Epithelial or Metastatic Ovarian Cancer Undergoing Neoadjuvant Chemotherapy

Background: 70% of ovarian cancer cases are diagnosed at an advanced stage (III or IV) of the disease and, in turn, with a high prevalence of peritoneal carcinosis and ascites, which leads to progressive malnutrition in patients, with the consequent deterioration of their general condition. There is a very important relationship between nutritional status, quality of life, survival, and the ability to tolerate multidisciplinary treatment of peritoneal carcinosis. Methods: A phase II, open-label, single-center, non-randomised clinical trial was conducted that included 36 patients with advanced disease who were administered the nutritional supplement Ocoxin, 30 ml twice a day, beginning one week before chemotherapy (CT) based on carboplatin/paclitaxel, of which they receive three cycles with neoadjuvant intent. Ocoxin treatment was continued during chemotherapy and for three weeks after completion of the last cycle, as well as during any periods for which this treatment was discontinued due to toxicity. The effect of Ocoxin on the quality of life was assessed through the QLQ C30 and QLQ OV28 questionnaires from the start of treatment until the end of the follow-up period. In addition, the Karnofsky Index and nutritional parameters were assessed. Results: There were no significant differences between adverse events versus baseline values, except in leukocytes, lymphocytes, neutrophils, ALT, and AST. There was no deterioration of the QoL scales, except for those related to the effects of chemotherapy and alopecia. Conclusions: Ocoxin as an adjuvant to chemotherapy appears to improve better tolerance to chemotherapy, showed a good safety profile, and improved quality of life. For further information on Ocoxin neoadjuvant therapy benefits, a phase III clinical trial will be needed.

Effect of Intraperitoneal Administration of Paclitaxel Combined with Cisplatin in Treatment of Advanced Ovarian Cancer

Objective:To analyze the effect of intraperitoneal administration of paclitaxel combined with cisplatin in treatment of advanced ovarian cancer.Method:Fifty-four patients with advanced ovarian cancer in our hospital were randomly selected from the beginning of July 2018 to the end of June 2019.The principle of grouping was based on double-blind randomization method.In experimental group,27 patients were given intraperitoneal administration of paclitaxel combined with cisplatin.In control group,27 patients were given intravenous administration of paclitaxel combined with cisplatin.Clinical data of the two groups were compared.Results:Short-term clinical efficacy and T lymphocyte subsets of experimental group were significantly improved when compared with control group.The difference was significant(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion:The effect of intraperitoneal administration of paclitaxel combined with cisplatin is ideal for treatment of advanced ovarian cancer patients.

KIAA1199 induces advanced biological behavior and development of ovarian cancer through activation of the IL-6/STAT3 pathway

Recently,abnormal expression of KIAA1199 has been detected in Epithelial Ovarian Cancer(EOC).However,the underlined anti-ovarian cancer mechanism of KIAA1199 remains to be enlightened.In our study,we performed to elucidate the effects of KIAA1199 on the advanced biological behavior of EOC cells through activation of the IL-6/STAT3 pathway.Confirmed by immunohistochemistry,KIAA1199 was highly expressed in ovarian borderline and malignant epithelial tumors.A retrospective analysis found that EOC patients with low expression of KIAA1199 had a significantly higher 5-year survival rate than those with high expression.Mechanistically,IL-6 was used to stimulate EOC cells,and the expression of KIAA1199,STAT3 and p-STAT3 increased after IL-6 stimulation.These results could show that KIAA1199 is transcriptionally activated by IL6/STAT3 pathway,thereby accelerating the deterioration of EOC.KIAA1199 could also be used as a poor prognosis factor and potential target in treatment.

Cytoreductive surgery and HIPEC after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

AIM: To reduce postoperative complications and to make possible an optimal cytoreduction, neoadjuvant chemotherapy(NACT) followed by interval debulking surgery has been applied with encouraging results. METHODS: Between December 2009 and February 2012, patients with stage ⅢC-Ⅳ epithelial ovarian cancer(EOC) underwent diagnostic laparoscopy, to assess the feasibility of optimal debulking surgery. The modifi ed Fagotti score was applied to assess the feasibility of resection with zero residual tumor. Patients who were not candidate for upfront debulking surgery were submitted to NACT, then reassessed according to the RECIST 1.1 criteria and submitted to cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) if they showed clinical response or stable disease. The remaining cycles of adjuvant systemic chemotherapy(ASCT) were administered postoperatively, to complete 6 cycles of systemic chemotherapy.RESULTS: Nine patients were included. Clinical response to NACT was complete in 3 patients and partial in 5 patients; one patient had stable disease. All patients underwent CRS resulting in CC0 disease prior to HIPEC. Average operative time was 510 min. Average intensive care unit stay was 2 d. Average postoperative hospital stay was 25 d. No postoperative mortality was observed. One patient experienced pelvic abscess. One patient refused ASCT. The remaining 8 patients started ASCT. Average time to chemotherapy was 36 d. All patients are alive, with an average follow up of 11 mo. Eight patients are disease-free at follow up.CONCLUSION: HIPEC after CRS for advanced EOC is feasible with acceptable morbidity and mortality. NACT may increase the chance for achieving complete cytoreduction. Phase 3 studies are needed to determine the effects of HIPEC on survival.

Neoadjuvant Chemotherapy Followed by Surgery versus Primary Surgery in Advanced Epithelial Ovarian Cancer: A Review of Outcomes at National Institute of Cancer Research Hospital in Bangladesh

Introduction: This study evaluated the difference in operative and clinical outcomes for patients with advanced ovarian cancer after primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in Bangladesh. Methods: Sixty patients with advanced epithelial ovarian cancer presenting to the department of Gynaecological Oncology at the National Institute of Cancer Research and Hospital were prospectively enrolled. Thirty patients underwent primary debulking surgery and thirty patients received NACT followed by IDS. Results: In the PDS and IDS groups respectively, 56.7% and 50% of patients presented with stage IIIC and 67.7% and 56.7% respectively had serious papillary type histopathology. Duration of surgery, amount of blood loss and total hospital stay were significantly lower (p < 0.001) in IDS group than in the PDS group. There was a statistically significant difference in postoperative tumor residuals between IDS and PDS patients. Complete tumor resection (R0) was obtained in 24 (80%) of IDS patients versus 13 (43.3%) PDS patients. In fifteen months of follow-up, 21 (70%) in the PDS group and 5 (16.7%) in the IDS group recurred (p = 0.021). Median progression free survival in PDS patients was twelve months while that of the IDS group was seventeen months. There was one death at 45 days in the PDS group. No other deaths were documented at fifteen months of follow-up. Conclusion: Interval debulking surgery has a more favorable outcome than primary debulking surgery on progression free survival in advanced ovarian cancer patients and permits a less aggressive surgery to be performed in Bangladesh.

Value of neoadjuvant chemotherapy in advanced ovarian cancer

Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.

Advanced ovarian cancer: Neoadjuvant chemotherapy plus surgery and HIPEC as up-front treatment

Epithelial ovarian cancer （EOC） is one of the most com-mon malignancies and one of the principal causes of death in gynecological neoplasms. The majority of EOC patients present with an advanced International Fed-eration of Gynecology and Obstetrics stage disease. The current standard treatment for these patients con-sists of complete cytoreduction and combined systemic chemotherapy of a platinum agent and paclitaxel. Even if the majority of patients with EOC respond to frst-line platinum based chemotherapy, almost 20% of them are resistant or refractory. According to these data, the main risk is for a certain number of patients to have undergone cytoreductive surgery （CRS） and subsequent hyperthermic intraoperative peritoneal chemotherapy （HIPEC） in a useful way. Radical surgery, especially in advanced cases, is associated with a high incidence of postoperative morbidity and mortality, which could be increased by the HIPEC. Every effort should be made for previously selected patients to improve outcome and optimize resources. Over the last decade, new options have been introduced to prolong survival. Im-proved long-term results can be achieved using CRS in combination with intraoperative HIPEC. This combina-tion has also been used in an up-front setting. Contro-versial outcomes have been reported for neoadjuvant platinum-based chemotherapy. Different papers have been published reporting discordant results. Further studies are needed.

Effect of continuous recombinant human endostatin pumping combined with TP chemotherapy on serum malignant molecules and angiogenesis molecules in patients with advanced ovarian cancer

Objective:To study the effect of continuous recombinant human endostatin pumping combined with TP chemotherapy on serum malignant molecules and angiogenesis molecules in patients with advanced ovarian cancer.Methods:78 patients with advanced ovarian cancer who were treated in our hospital between July 2011 and December 2015 were selected and divided into observation group and control group (n=39) according to the single-blind randomized control method. Before treatment and after 4 cycles of treatment, electrochemical luminescence immunity analyzer was used to detect serum tumor marker levels;RIA method was used to determine serum apoptosis molecule levels;enzyme-linked immunosorbent assay (ELISA) was used to detect the serum angiogenesis molecule levels.Results:Before treatment, differences in serum levels of tumor markers, apoptosis molecules and angiogenesis molecules were not statistically significant between two groups of patients (P>0.05). After 4 cycles of treatment, serum carbohydrate antigen 125 (CA125), carbohydrate antigen 153 (CA153), human epididymis protein 4 (HE4), carcinoembryonic antigen (CEA), human chorionic gonadotropin (β-HCG), Bcl-2, Survivin, Bag-1, angiogenin-2 (Ang-2), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) levels of observation group were significantly lower than those of control group (P<0.05) while Bax level was significantly higher than that of control group (P<0.05).Conclusions:Continuous recombinant human endostatin pumping combined with TP chemotherapy can decrease the malignant degree of advanced ovarian cancer and inhibit angiogenesis.