卵巢癌的治疗课件.pptVIP

* * Six additional phase II trials of other agents target tumor angiogenesis but in a manner independent of VEGF. Drugs: imatinib (Gleevec?) * The 6-months timeframe as a definition for platinum-sensitive vs platinum-resistant ovarian cancer patients is primarily for clinical trial purposes. Sensitivity and resistance to platinum is better viewed as a continuum. The definitions shown here for sensitivity were developed based on measurable ovarian cancer at first relapse and did not take into account CA-125 levels. * * * * * * To detect recurrent ovarian cancer, we have several surveillance options: One could argue that a second-look laparotomy is actually a surveillance option. This is a controversial procedure, and is usually most appropriate as part of a clinical trial. The pendulum has swung away from routine use of second-look laparotomy, but it is still done occasionally. Physical examination, including pelvic exam, can help detect occult disease in the pelvis that’s not well imaged on a CT scan or other imaging modalities. CA-125 is not always a reliable marker for ovarian cancer. There can be false positive elevations or increases in CA-125, which is one of the reasons why it’s not reliable for ovarian cancer screening. In a patient with a history of ovarian cancer, particularly if their CA-125 was elevated at initial diagnosis, it can be a valuable marker that can aid in following disease. We recognize that some ovarian cancers have minimal or no CA-125 secretion. This appears to be particularly true for the non-serous histologies of ovarian cancer; clear cell, mucinous and endometrioid. For patients with these histologies we may be limited to detecting disease when it has crossed a threshold of symptomatic or measurable disease volume. Many questions surround the use of imaging as a surveillance option: Should we do routine imaging? Should we use this only in certain settings? What type of imaging is best? CT scan, MRI, or PET scan? Of these options, th