Ovarian Cancer上皮性卵巢癌ppt课件.ppt

Cytoreductive Surgery Further studies by Eisenkop (2003), Bristow (2002, 2006) and Chi (2008) all support the value of optimal cytoreductive surgery. Optimal cytoreduction has been shown to increase platinum sensitivity Chi et al. The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer. Gynecol Oncol 2008; 108: 276-81. Every effort should be given to achieve microscopic residual disease while balancing the unique co-morbidities of the patient Food for thought… Should a 78-year-old patient with O2 dependent COPD/DM/HTN/A-fib undergo an ovarian cancer debulking, hepatectomy, splenectomy and low anterior resection of rectosigmoid colon? Historical GOG trials McGuire WP et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. NEJM 1996; 334: 1-6. GOG #111 Phase III, randomized, controlled trial Objective- to evaluate the response between 6 cycles of cyclophosphamide (750 mg/m2) and cisplatin (75 mg/m2) Q 21 days vs. 6 cycles of paclitaxel (135 mg/m2) and cisplatin (75 mg/m2) Q 21 days Historical GOG trials Methods- Eligibility: Stage III Stage IV Residual disease 1cm Primary endpoint PFS- measured from the date of randomization Secondary endpoint OS- measured from the date of randomization Historical GOG trials Results 386 patients Majority of patients Stage III Grade 3 Serous adenocarcinoma Cyclophosphamide/ Cisplatin Paclitaxel/ Cisplatin P value N 202 184 Response Rate 60% 73% 0.01 Complete Response 31% 51% 0.01 Partial Response 29% 22% NS PFS 13 mo 18 mo 0.001 OS 24 mo 38 mo 0.001 Historical GOG trials Conclusion For suboptimally debulked Stage III and Stage IV epithelial ovarian cancer, Paclitaxel and Cisplatin provides a superior OS and PFS compared with Cyclophosphamide and Cisplatin Standard of care shifted to Paclitaxel and Cisplatin Early ovarian cancer (Stage I) Methods-