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背景与目的:复发性卵巢癌治疗效果差,尚无统一的治疗方法。合理的综合治疗有可能提高疗效。本文旨在探讨全腹放疗在复发性卵巢癌综合治疗中的作用。方法:11例复发性卵巢癌采用铂类或紫杉醇为主的二线化疗,复发病灶较为局限于腹盆腔内者行二次肿瘤细胞减灭术,并在化疗达肿瘤缓解后给与全腹放疗。结果:全组二线化疗平均7个(5-11个)疗程,二线化疗后均获临床完全缓解。8例患者接受了再次肿瘤细胞减灭术,7例术后残留病灶≤1cm。化疗临床缓解后进行全腹分段超分割放疗,7例完成全部放疗计划,腹腔平均总量30.2Gy(29.96~31.2Gy),4例盆腔加量至45.1Gy(44.98~45.12Gy)。平均随访40.9月,中位生存时间超过60月,3年、5年总生存率分别为90.91%和81.82%。复发后3年生存率达72.73%。经二线治疗后再获临床缓解后,肿瘤再复发10例,中位无瘤生存时间22.0月,复发治疗后1~3年无瘤生存率分别为72.73%,45.45%和18.18%。1~3年腹盆腔内局部肿瘤控制率分别为72.7%(8/11),63.6%(7/11)和54.5%(6/11)。放疗期间主要毒性反应为骨髓抑制,Ⅲ级粒细胞毒性和Ⅲ级血小板毒性均为3例(27.3%)。胃肠道反应多数Ⅰ/Ⅱ级。随访远期毒性,1例出现持续性血小板下降(Ⅲ级),1例放疗后肠粘连引起肠梗阻。结论:初步结果表明复发性卵巢癌在二线化疗达临床缓解后加用全腹放疗可提高腹盆腔局部肿瘤控制率,延缓肿瘤的再复发,延长患者的生存期。全腹分段超分割放疗的急性反应较轻,多数患者可耐受。
Background and Objective: The treatment of recurrent ovarian cancer is poor, there is no uniform treatment. Reasonable comprehensive treatment may improve the curative effect. This article aims to investigate the role of total abdominal radiation in the treatment of recurrent ovarian cancer. Methods: 11 cases of recurrent ovarian cancer with platinum or paclitaxel-based second-line chemotherapy, recurrent lesions were more limited to the abdominal cavity of the second tumor cytoreductive surgery, and chemotherapy in the tumor response to complete abdominal radiotherapy. Results: The average second-line chemotherapy in the whole group was 7 (5-11) courses and achieved complete clinical remission after second-line chemotherapy. Eight patients underwent repeat cytoreductive surgery and seven patients had residual lesions ≤1 cm. Seven patients underwent complete radiotherapy after complete remission. The average intraperitoneal volume was 30.2Gy (29.96-31.2Gy) and the volume of pelvic cavity was 45.1Gy (44.98-45.12Gy) in 7 patients. With a mean follow-up of 40.9 months, the median survival time exceeded 60 months, and the 3-year and 5-year overall survival rates were 90.91% and 81.82% respectively. Three years after recurrence survival rate of 72.73%. After second-line treatment and remission, the recurrence of tumor recurrence in 10 cases, median tumor-free survival time of 22.0 months, 1 to 3 years after recurrence-free survival rates were 72.73%, 45.45% and 18.18%. The control rates of intra-abdominal local tumors in one to three years were 72.7% (8/11), 63.6% (7/11) and 54.5% (6/11), respectively. The main toxicities during the radiotherapy were myelosuppression, grade Ⅲ cytotoxicity and grade Ⅲ platelet toxicity in 3 cases (27.3%). Most gastrointestinal reactions Ⅰ / Ⅱ grade. Follow-up long-term toxicity, 1 case of sustained thrombocytopenia (grade Ⅲ), 1 case of intestinal adhesion caused by intestinal radiotherapy after intestinal obstruction. CONCLUSIONS: The preliminary results indicate that the treatment of recurrent ovarian cancer with second-line chemotherapy after complete remission may improve the rate of local tumor control in the pelvic cavity, delay the recurrence of tumor and prolong the survival of patients with recurrent ovarian cancer. The whole abdominal sub-fractional radiotherapy acute response lighter, most patients can tolerate.