复发性卵巢癌的化放疗研究  

Integrated chemoradiotherapy for recurrent epithelial ovarian cancer

作　　者：汤洁[1] 蔡树模[1] 黄啸[1] 李子庭[1] 臧荣余[1] 

机构地区：[1]复旦大学附属肿瘤医院妇科,上海200032

出　　处：《肿瘤》2007年第8期638-641,650,共5页Tumor

摘　　要：目的：分析化疗结合放疗对复发性卵巢癌治疗的疗效。方法：30例复发性卵巢癌采用铂类或紫杉醇为主的二线化疗，并根据患者肿瘤复发部位或再次手术后腹盆腔内残留病灶选用盆腔或全腹放疗。结果：平均二线化疗7个（3—14）个疗程，20例患者二线化疗后获临床完全缓解。21例患者接受了再次肿瘤细胞减灭术，16例术后残留病灶≤1cm。二线化疗期间结合放疗，23例行盆腔放疗，平均总量42．2（30．0～45．12）Gy，7例行全腹分段超分割放疗，平均总量30．2（29．96～31．2）Gy，其中4例盆腔加量至45．1（44．98～45．12）Gy。平均随访41．0个月，中位总生存时间57．0个月，患者3年、5年总生存率分别为73．33％、46．67％。复发后中位生存时间38．9个月，复发后3年生存率达56．34％。单因素和多因素分析结果提示二线化疗疗效（HR=0．26，P〈0．01）和停铂化疗间期（HR=-0．21，P〈0．01）影响复发患者的总生存期，二线化疗也是决定患者复发后生存期的独立因素（HR=0．25，P〈0．01）。结论：二线化疗是决定复发性卵巢癌生存期的重要因素，在二线化疗的基础上配合盆腔或全腹放疗可延长患者的生存期，特别是在二线化疗达临床缓解后加用放疗可提高腹盆腔局部肿瘤控制率，延缓肿瘤的再复发。Objective： To study the therapeutic effects of integrated chemotherapy and radiotherapy on recurrent epithelial ovarian cancer. Methods： Thirty patients with recurrent epithelial ovarian cancer received platinum-or paclitaxel-based second-line chemo- therapy. The whole abdominal irradiation or pelvic irradiation was selected according to the recurrent sites and the intra-abdominopelvic lesions after secondary cytoreduction. Results： Patients received average 7 courses （3-14 courses） of second-line chemotherapy and twenty patients had complete response. Twenty-one patients received secondary cytoreductive surgery. Optimal surgical cytoreduction was obtained in 16 cases with residual diseases ≤1 cm. During the second-line chemotherapy, 23 cases received pelvic radiation at an average total dosage of 42.2 （30.0-45.12） Gy and another 7 cases received whole abdominal split-course hyperfractionated radiation at an average total dosage of 30.2 （29.96-31.2 ）Gy and 4 patients received pelvic boost irradiation at an average dosage of 45.1 （44.98- 45.12） Gy. The mean follow-up period was 41.0 months. The median overall survival time was 57.0 months and the 3- and 5-year overall survival rate of the patients were 73.33% and 46.67% , respectively. The median survival time was 38.9 months and the 3-year survival rate was 56.34% after recurrence. Univariate and multivariate analyses showed that the effect of second-line chemotherapy （ HR = 0.26, P 〈 0.01 ） and platinum-free interval （PFI） （ HR = 0.21, P 〈 0.01 ） significantly influenced the overall survival of recurrent patients. Second-line chemotherapy is an independent prognostic factor influencing the survival time of recurrent patients （ HR = 0.25, P 〈 0.01 ）. Conclusion： The second-line chemotherapy was an independent prognostic factor influencing the survival time of patients with recurrent ovarian epithelial cancer. Second-line chemotherapy combined with pelvic or whole abdominal irradiation prolong the survival time of pa

关 键 词：卵巢肿瘤 复发 药物疗法 放射疗法 预后 

分 类 号：R737.31[医药卫生—肿瘤]