Entwicklungen in der Therapie des fortgeschrittenen Ovarialkarzinoms FIGO III

Abstract

From 1982 to 1992 103 patients with ovarian cancer stage FIGO III have been treated. In 38% of the patients there was no residual tumour postoperatively, in 40.8% the residual tumour was smaller than 2 cm. In 51.5% bowel resections were necessary, a stoma was unavoidable in just one case. A lymphadenectomy (pelvic, paraaortic or combined) was done in 46.6% of the patients. Postoperatively, 54.4% of the patients received a platinum-based chemotherapy, in the other patients other kinds of chemotherapy were applied. A radiation of the whole abdomen was done only in 3.9%. A median survival time for more than 60 months could be achieved in tumour-free patients due to the increased radical operations in combination with the platinum based chemotherapy. The lymphadenectomy seems to prolong the survival time of the patients. The positive nodal status is definitely unfavourable for the prognosis. By this therapeutic approach, an increased survival time with a good life quality can be achieved.

Neoadjuvant chemotherapy followed by tumor debulking prolongs survival for patients with poor prognosis in International Federation of Gynecology and Obstetrics Stage IIIC ovarian carcinoma

“…Current treatment of advanced ovarian carcinoma consists of surgical tumor resection—as complete as possible—followed by platinum/taxane‐based chemotherapy. In this therapeutic procedure, postsurgical macroscopic tumor free status is the decisive prognostic factor for subsequent disease course 1–6. Hence, in the past few years, increasingly radical surgery has been used with the intention of increasing the percentage of macroscopically tumor free patients; in surgical centers, it now is possible to achieve a complete tumor resection in approximately 40% of patients 7.…”

Prognostic significance of urokinase (uPA) and its inhibitor PAI-1 for survival in advanced ovarian carcinoma stage FIGO IIIc

“…During the last years, refined and more radical operation techniques as well as adjuvant combination chemotherapy have significantly improved the survival of patients with advanced ovarian cancer (Griffiths et al, 1979;Heintz et al, 1986;Bertelsen, 1990;Jänicke et al, 1992;Kuhn et al, 1993). Yet, radical resection of the tumour mass, which so far represents the strongest prognostic marker for survival probability, still could not prevent disease recurrence and subsequent death in over 70% of cases.…”

Die Bedeutung der radikalen zytoreduktiven Chirurgie für die Überlebenszeit von Patientinnen mit fortgeschrittenem Ovarialkarzinom

“…Anders als z. B. bei Kuhn et al [34], in dessen Untersuchung Aszitesmengen über 500 ml als Surrogatmarker einer aggressiveren Tumorbiologie auch mit einer erniedrigten Tumorresektionsrate korrelieren, unterscheiden sich die Überlebens-und Rezidivraten, wie auch die Komplikationsraten, in unseren gut definierten Subgruppen nicht. Dass sich bei den Patientinnen, bei denen makroskopische Tumorfreiheit erreicht wurde, trotz der Präsenz der oben genannten negativen tumorbiologischen Indikatoren diese Endpunkte in unserer Untersuchung nicht unterscheiden, untermauert die Hypothese, dass die Prognose nicht so sehr von der Tumorbiologie und dem Tumorausbreitungsmuster abhängt, sondern dass vor allem der Größe des postoperativ verbliebenen Tumorrestes und damit dem Operationserfolg die maßgebliche Bedeutung als Prognosefaktor zukommt.…”