晚期卵巢癌的先期化療(Neoadjuvant Chemotherapy)

Abstract

Primary debulking surgery followed by chemotherapy is the current treatment for advanced (stage Ⅲ or Ⅳ) ovarian cancer. However, there is uniform agreement in the literature about the poorer outcome of patients in which bulky residual disease fail to undergo optimum cytoreduction. Neoajuvant chemotherapy which provide the same chemotherapy initially and following the chemotherapy with surgery has been proposed as an alternative approach to conventional surgery as initial management of bulky ovarian cancer. Some reports suggested that neoajuvant chemotherapy is the preferred management of advanced ovarian cancer. Belgium University demonstrated that higher crude 3-year survival rates and lower postoperative mortality rates were observed during the period when neoajuvant chemotherapy was used. M.D. Anderson Cancer Center showed highter optimal cytoreduction rate in the neoadjuvant chemotherapy group. Schwartz PE et. Al. At Yale-New Haven Medical Center reported that women treated with neoadjuvant chemotherapy have the same overall survival as women treated in a conventional fashion with aggressive cytoreductive surgery followed by the platinum-based chemotherapy despite the neoaduvant group being significant older and having a poorer performance status. In addition, neoadjuvant treated patients who underwent surgery had reduced operative morbidity with statistical reductions in estimated blood loss, postoperative intensive care unit stays, and hospitalization time compared to the conventionally treated patients. A French multicenter study demonstrated that neoadjuvant chemotherapy for primary unresectable ovarian carcinoma leads t6o the selection of a subset of chemosensitive patients. Aggressive surgery can be avoided in patients with initial chemoresistance, in whom the prognosis is known to be poor regardless of treatment. Usually, three to six cycles of chemotherapy are performed before debulking surgery. The role of neoadjuvant chemotherapy should now be evaluated in a prospective randomized study for patients with advanced ovarian cancer.