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首页> 外文期刊>Cancer Biology >Integration of Neoadjuvant Chemotherapy and Interval Debulking Surgeries in Patients with Advanced Epithelial Ovarian Cancer
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Integration of Neoadjuvant Chemotherapy and Interval Debulking Surgeries in Patients with Advanced Epithelial Ovarian Cancer

机译：晚期上皮性卵巢癌患者新辅助化疗与间隔减瘤手术的整合

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Neoadjuvant chemotherapy (NAC) and interval debulking surgery (IDS) after 3 NAC cycles is an acceptable approach to achieve optimal cytoreduction in patients with advanced epithelial ovarian cancer (AEOC) who are not candidate for primary debulking surgery (PDS). The best timing of cytoreductive surgery and the role of late debulking surgery (LDS) after 6 cycles of NAC are still unclear. We aimed to study the outcome of such patients who were treated in our centre in the Royal Stoke University Hospital, Stoke-On-Trent between July 2009 and July 2014. One hundred and eight patients with AEOC were treated under our gynaecology oncology team during that period. Sixty six patients (61.1%) were in stages III and 42 (38.9%) in stage IV. All patients received NAC; 64 patients (59.3%) had paclitaxel and carboplatin regimen and 44 (40.7%) single agent carboplatin. Response to chemotherapy was assessed after 2 cycles; 81 patients (75%) had partial response, 21 (19.4%) stable disease and 6 (5.6%) progressive disease. Forty one patients (38%) proceeded to IDS after cycle 3 and 11 patients (10.2%) to LDS after cycle 6 but 56 (51.9%) had no debulking surgery (NDS). After a median follow up period of 18 months (range 6-84 months), 95 patients (88%) had relapsing/progressive disease. The median PFS durations were 13 and 12 months for patients who had either IDS and LDS respectively compared to 8 months for NDS. The 2 years PFS probabilities were 18% for patients who had IDS, 15% for LDS compared to 0% for NDS (P 0.000 Log rank test). The median overall survival (OS) durations were 48, 33 and 18 months for patients who had IDS, LDS and NDS respectively. The 2 years OS probabilities were 75% for patients who had either IDS, or LDS compared to 38% for NDS (P.000 Log rank test). In our study, we documented PFS and OS advantages for patients who IDS or LDS compared to NDS and therefore should be considered whenever possible as part of the primary treatment of AEOC patients. Interval debulking surgery (IDS) offers longer duration and higher probabilities of PFS and OS compared to LDS. More patients-therefore- should be selected for IDS. There is a need for improving NAC possibly with integrating target agents and the use of more intensified schedules.
机译：在3个NAC周期后进行新辅助化疗（NAC）和间歇性减灭术（IDS）是可以接受治疗的晚期上皮性卵巢癌（AEOC）患者的最佳细胞减少方法，这些患者不适合进行原发性减瘤术（PDS）。 NAC的6个周期后，细胞减灭术的最佳时机和后期减体手术（LDS）的作用仍不清楚。我们的目的是研究2009年7月至2014年7月在我们位于特伦特河畔斯托克的皇家斯托克大学医院中心接受治疗的患者的结局。在此期间，我们的妇科肿瘤小组对108名AEOC患者进行了治疗期。 Ⅲ期患者有66例（61.1％），Ⅳ期患者有42例（38.9％）。所有患者均接受NAC治疗; 64例（59.3％）患者接受了紫杉醇和卡铂方案，单药44例（40.7％）接受卡铂。 2个周期后评估对化学疗法的反应。 81例患者（75％）有部分缓解，21例（19.4％）稳定疾病和6例（5.6％）进行性疾病。在第3周期后有41例患者（38％）接受了IDS治疗，在第6周期后有11例患者（10.2％）接受了LDS治疗，但有56例（51.9％）的患者没有进行减囊手术（NDS）。在中位随访期为18个月（6-84个月）后，有95名患者（88％）患有复发/进展性疾病。 IDS和LDS患者的中位PFS持续时间分别为13个月和12个月，而NDS患者为8个月。 IDS患者的2年PFS概率为18％，LDS为15％，而NDS为0％（P 0.000 Log Rank检验）。 IDS，LDS和NDS患者的中位总生存期（OS）分别为48、33和18个月。患有IDS或LDS的患者的2年OS机率是75％，而使用NDS的患者的2年OS概率是38％（P.000对数秩检验）。在我们的研究中，我们记录了IDS或LDS相比NDS的患者在PFS和OS方面的优势，因此应尽可能考虑将其作为AEOC患者主要治疗的一部分。与LDS相比，间歇性减脂术（IDS）可以提供更长的持续时间和更高的PFS和OS概率。因此，应选择更多的患者进行IDS。有必要通过整合目标代理和使用更严格的时间表来改进NAC。

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