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Активная хирургическая тактика в современном алгоритме лечения распространенного рака яичника
Активная хирургическая тактика в современном алгоритме лечения распространенного рака яичника
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Аннотация
Введенное в хирургию рака яичников понятие оптимальной циторедуктивной операции менялось на протяжении последних трех декад от 3 см остаточной опухоли до 1 см. В последние годы многие западные специалисты считают, что адекватным объемом циторедукции может быть только полное удаление всех видимых проявлений заболевания без макроскопически определяемой остаточной опухолевой ткани, т.е. полная циторедукция. Эти рассуждения основаны на полученных в последнее время данных. В настоящей работе акцентировано внимание на важности выполнения оптимальных и полных циторедукций с позиции доказательной медицины. Также в работе обсуждается место индукционной химиотерапии перед циторедуктивной операцией, акцентировано внимание на возможности предсказания вероятности выполнения оптимальной или полной циторедукции на первом этапе.
Ключевые слова: рак яичников, циторедуктивные операции, индукционная химиотерапия.
Key words: ovarian cancer, debulking surgery, induction chemotherapy.
Ключевые слова: рак яичников, циторедуктивные операции, индукционная химиотерапия.
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Key words: ovarian cancer, debulking surgery, induction chemotherapy.
Полный текст
Список литературы
1. Du Bois A, Quinn M, Thigpen T et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol 2005; 16 (S8): viii7–12.
2. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975; 42: 101.
3. Bristow RE, Tomacruz RS, Armstrong DK et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002; 20: 1248–59.
4. Crawford SC, Vasey PA, Paul J et al. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial. J Clin Oncol 2005; 23 (34): 8802–11.
5. du Bois A, Reuss A, Pujade-Lauraine E et al. The role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer. A combined exploratory analysis of three prospectively randomized phase III multicenter trials by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009; 6: 1234–44.
6. Hoskins WJ, Bundy BN, Thigpen JT, Omura GA. The influence of cytoreductive surgery on recurrence-free interval and survival in small volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 1992; 47: 159.
7. Armstrong DK, Bundy B, Wenzel L et al. Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006; 354 (1): 34–43.
8. Bristow RE, Montz FJ, Lagasse LD et al. Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol 1999; 72: 278–87.
9. Zang RY, Zhang ZY, Cai SM et al. Cytoreductive surgery for stage IV epithelial ovarian cancer. J Exp Clin Cancer Res 1999; 18: 449–54.
10. Akahira JI, Yoshikawa H, Shimizu Y et al. Prognostic factors of stage IV epithelial ovarian cancer: A multicenter retrospective study. Gynecol Oncol 2001; 81: 398–403.
11. van der Burg ME, van Lent M, Buyse M et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecologic Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 1995; 332: 629.
12. Schwartz PE, Chambers JT, Makuch R. Neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol 1994; 53: 33.
13. Bristow RE, Chi DS. Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis. Gynecol Oncol 2006; 103 (3): 1070–6.
14. Rose PR, Nerenstone F, Brady MF et al. Secondary surgical cytoreduction for advanced ovarian carcinoma N Engl J Med 2004; 351: 2489–97.
15. Vergote I, Trope C, Amant F et al. EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC-IV ovarian, fallopian tube and peritoneal cancer (OVCA). Abstract presented at 12th Biennial Meeting International Gynecologic Cancer Society, Bangkok, Thailand, 2008.
16. Hariprasad R, Kumar L, Mookerjee A et al. Interval from neoadjuvant chemotherapy to interval debulking surgery in advanced ovarian cancer: Is this a prognostic indicator? J Clin Oncol (Meeting Abstracts) 2010; 28: 5084.
17. Chi DS, Venkatraman ES, Masson V et al. The ability of preoperative CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol 2000; 77: 227–31.
18. Saygili U, Guclu S, Uslu T et al. Can serum CA-125 levels predict the optimal primary cytoreduction in patients with advanced ovarian carcinoma? Gynecol Oncol 2002; 86: 57–61.
19. Cooper BC, Sood AK, David CS et al. Preoperative CA-125 levels: An independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol 2002; 100: 59–64.
20. Memarzadeh S, Lee SB, Berek JS et al. CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer 2003; 13: 120–4.
21. Bristow RE, Duska LR, Lambrou NC et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer 2000; 89: 1532–40.
22. Dowdy SC, Mullany SA, Brandt KR et al. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer 2004; 101: 346–52.
23. Axtell AE, Lee MH, Bristow RE et al. Multiinstitutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol 2007; 25: 384–9.
24. Crawford SC, Vasey PA, Paul J et al. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial. J Clin Oncol 2005; 23: 8802–11.
2. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975; 42: 101.
3. Bristow RE, Tomacruz RS, Armstrong DK et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002; 20: 1248–59.
4. Crawford SC, Vasey PA, Paul J et al. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial. J Clin Oncol 2005; 23 (34): 8802–11.
5. du Bois A, Reuss A, Pujade-Lauraine E et al. The role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer. A combined exploratory analysis of three prospectively randomized phase III multicenter trials by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009; 6: 1234–44.
6. Hoskins WJ, Bundy BN, Thigpen JT, Omura GA. The influence of cytoreductive surgery on recurrence-free interval and survival in small volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 1992; 47: 159.
7. Armstrong DK, Bundy B, Wenzel L et al. Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006; 354 (1): 34–43.
8. Bristow RE, Montz FJ, Lagasse LD et al. Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol 1999; 72: 278–87.
9. Zang RY, Zhang ZY, Cai SM et al. Cytoreductive surgery for stage IV epithelial ovarian cancer. J Exp Clin Cancer Res 1999; 18: 449–54.
10. Akahira JI, Yoshikawa H, Shimizu Y et al. Prognostic factors of stage IV epithelial ovarian cancer: A multicenter retrospective study. Gynecol Oncol 2001; 81: 398–403.
11. van der Burg ME, van Lent M, Buyse M et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecologic Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 1995; 332: 629.
12. Schwartz PE, Chambers JT, Makuch R. Neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol 1994; 53: 33.
13. Bristow RE, Chi DS. Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis. Gynecol Oncol 2006; 103 (3): 1070–6.
14. Rose PR, Nerenstone F, Brady MF et al. Secondary surgical cytoreduction for advanced ovarian carcinoma N Engl J Med 2004; 351: 2489–97.
15. Vergote I, Trope C, Amant F et al. EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC-IV ovarian, fallopian tube and peritoneal cancer (OVCA). Abstract presented at 12th Biennial Meeting International Gynecologic Cancer Society, Bangkok, Thailand, 2008.
16. Hariprasad R, Kumar L, Mookerjee A et al. Interval from neoadjuvant chemotherapy to interval debulking surgery in advanced ovarian cancer: Is this a prognostic indicator? J Clin Oncol (Meeting Abstracts) 2010; 28: 5084.
17. Chi DS, Venkatraman ES, Masson V et al. The ability of preoperative CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol 2000; 77: 227–31.
18. Saygili U, Guclu S, Uslu T et al. Can serum CA-125 levels predict the optimal primary cytoreduction in patients with advanced ovarian carcinoma? Gynecol Oncol 2002; 86: 57–61.
19. Cooper BC, Sood AK, David CS et al. Preoperative CA-125 levels: An independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol 2002; 100: 59–64.
20. Memarzadeh S, Lee SB, Berek JS et al. CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer 2003; 13: 120–4.
21. Bristow RE, Duska LR, Lambrou NC et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer 2000; 89: 1532–40.
22. Dowdy SC, Mullany SA, Brandt KR et al. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer 2004; 101: 346–52.
23. Axtell AE, Lee MH, Bristow RE et al. Multiinstitutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol 2007; 25: 384–9.
24. Crawford SC, Vasey PA, Paul J et al. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial. J Clin Oncol 2005; 23: 8802–11.
Авторы
И.А.Покатаев, М.Б.Стенина, А.С.Тюляндина, С.А.Тюляндин
Российский онкологический научный центр им. Н.Н.Блохина РАМН, Москва
N.N.Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Российский онкологический научный центр им. Н.Н.Блохина РАМН, Москва
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N.N.Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
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