早期卵巢癌: FIGO I and II

全面的分期手术
– 经腹全子宫/双侧卵巢输卵管切除 (TAH/BSO) – 大网膜切除 – 淋巴结切除术（dissection）：腹主动脉旁、盆腔 – 腹膜和膈膜活检（ biopsies） – 细胞学检查

高危 vs 低危早期卵巢癌
Staging classifications and clinical practice guidelines of gynaecologic cancers.
No Conflict of Interest
女性生殖道肿瘤: 全世界统计1
Cancer Cervical Endometrial
New Cases 470,000 189,000
Deaths 230,000 45,000
Ovarian
192,000
114,000
1. Ferlay et al. GLOBOCAN 2000 IARC, WHO 2001 (www.dep.iarc.fr)
– Cisplatin + paclitaxel vs cisplatin + cyclophosphamide – Improved survival and progression-free survival with cisplatin + paclitaxel

GOG 1323
– Cisplatin vs paclitaxel vs cisplatin + paclitaxel – No statistaical difference in overall survival

GOG 172 （2006）
– cisplatin + paclitaxel iv/ip preferred combination over cisplatin + paclitaxel iv

JGOG （2009）
– Carboplatin （d1）+ paclitaxel 80mg weekly perferred Carboplatin + paclitaxel
早期卵巢癌
低危
(5–10% 复发率)
Stage IA or IB
Grade 1 (or 2)
高危
(30–40% 复发率)
Stage IC
Grade 3 Clear cell cancer
Medical Oncology: A comprehensive review. textbook
卵巢癌化疗规范与进展
State of the art in chemotherapy for ovarian cancer
复旦大学附属肿瘤医院妇瘤科 吴小华
Xiaohua Wu M.D., Ph.D.
Dept. Gynecologic Oncology Fudan University Shanghai Cancer Center
months to deceased or last followup
新辅助化疗与中间性细胞减灭术

Neoadjuvant Chemotherapy Interval Cytoreduction
Neoadjuvant chemotherapy is not inferior to primary cytoreductive surgery for patients with stage IIIC or IV ovarian carcinoma. No significant advantages of neoadjuvant therapy or primary debulking surgery were observed with respect to survival, adverse effects, quality of life, or postoperative morbidity or mortality.
5-yr survival: 44% overall2
1. ACS Cancer Facts and Figures, 2011 2. Hoskins P, et al. J Clin Oncol. 1998;16:2233. Huang, Cancer 112:2289, 2008

上海市居民卵巢癌、宫颈癌、宫体癌发病率 （1974-2000，SCDC）
高危早期卵巢癌
GOG–1571,2
辅助化疗的随机临床试验: 3 vs 6 疗程 紫杉醇 + 卡铂
Action & Icon3
随机临床试验 无立即化疗 vs 立即化疗
结果
结果
6个疗程 进展危险性降低了33% 生存率无改善
立即化疗 生存率提高8% vs 复发时化疗 (82% vs 74%)
1. Young SGO 2003 2. Young RC. Semin Oncol 27 (3):8-10., 2000 3. ICON-1, EORTC-ACTION: J Natnl Can Inst. Vol. 95, No. 2, January 15, 2003 4. Mannel et al. GOG-175 protocol,
Principle Approach: IºTherapy
Chemotherapy
GOG-158 GOG-111
Cisplatin 75 mg/m2 22 Paclitaxel Cytoxan 750mg/m 135 mg/m
2 Carboplatin Cisplatin 75 AUC mg/m 7.5 Paclitaxel 175 135 mg/m2
OS (ms) NAC 29 vs 30 50
I. Vergote et al. N Engl J Med 2010; 363:943-953
一线化疗治疗: 标准方案选择
最大程度地减灭肿瘤细胞 残余肿瘤最大径<1cm
铂类 + 紫杉醇类化疗 (卡铂 + 紫杉醇)
晚期卵巢癌：关键临床实验1

GOG 1111 and OV-102

ICON-34
– Carboplatin + paclitaxel vs carboplatin or CAP (cyclophosphamide + doxorubicin + cisplatin) – No statistical differenceOVAR6
1. McGuire WP et al. N Engl J Med 1996, 334:1-8 2. Piccart M et al. Int J Gyn Cancer 2003, 13 (suppl 2), 144-148 3. Muggia F et al. J Clin Oncol 2000, 18:106-115
晚期卵巢癌: 关键临床实验2

ICON-5-GOG182 （2006）
– Carboplatin + paclitaxel vs Gemcitabin triplet vs Doxil Triplet vs Topotecan duble + TP vs Gemcitabin dublet + TP (cyclophosphamide + doxorubicin + cisplatin) – No statistical difference in survival
OS
GOG-111
PFS
Cisplatin 75 mg/m2 Cytoxan 750mg/m2 Cisplatin 75 mg/m2 Paclitaxel 135 mg/m2
McGuire New Engl J Med (1996) 334:1 Ozols, J Clin Oncol (2003) 21:3194 Armstrong New Engl J Med (2006) 354:34
全面的 分期手 术
晚期：FIGO III – IV期定义
III 盆腔外腹膜种植和/或外阳性腹膜后或腹股沟淋巴结
A 病灶大致局限于真骨盆; 淋巴结阴性; 镜下腹腔种植
B 腹腔种植灶 2 cm; 淋巴结阴性 C 腹腔种植灶 >2 cm 和/或阳性腹膜后淋巴结或腹股沟
IV 远处转移
Medical Oncology: A comprehensive review. textbook
Ovarian Cancer: Scope of Problem

Estimated incidence and mortality in the US (2011)1
– 21,550 new cases
– 14,600 deaths

Stage III/IV: 70-75%

Most recur: PFS: 10-26 mos
McGuire New Engl J Med (1996) 334:1 Ozols, J Clin Oncol (2003) 21:3194 Armstrong New Engl J Med (2006) 354:34
晚期卵巢癌的化疗
有效率
Optimal Stage III NA 75%
病理完全有效率
30
26.7 25
Ovarian Cancer Cervical Cacner Endometrial Cancer
Incidences ( /100,000)
20
15
10
10.5
11.2 9.1
6.5 5 4.8 2.5 4.4 2.5
6.3 4.4 4.8
0
1974 1994 Year 1997 2000
– Carboplatin + paclitaxel preferred combination over cisplatin + paclitaxel