of Ovarian Cancer 21st Century and Beyond卵巢癌的治疗 21世纪及展望ppt课件.ppt

* * What are some of the factors that help determine future treatment recommendations when ovarian cancer recurs? The treatment-free interval is extremely important to determine optimal therapy for recurrent disease. We also consider the impact of consolidation/maintenance therapy. Many of us continue to use paclitaxel based on the consolidation or maintenance studies. We consider the number of prior regimens and the response the patient had to these prior regimens. How fast did their CA-125 decline? What kind of toxicity did the patient experience from prior therapy? Did they require growth factor support, transfusion support, and do they have residual peripheral neuropathy? The volume and site of disease is also one of the factors. A patient who has ascites and GI symptomatology is quite different than someone whose performance status is zero and really just has a tumor marker or small volume disease. * * To detect recurrent ovarian cancer, we have several surveillance options: One could argue that a second-look laparotomy is actually a surveillance option. This is a controversial procedure, and is usually most appropriate as part of a clinical trial. The pendulum has swung away from routine use of second-look laparotomy, but it is still done occasionally. Physical examination, including pelvic exam, can help detect occult disease in the pelvis that’s not well imaged on a CT scan or other imaging modalities. CA-125 is not always a reliable marker for ovarian cancer. There can be false positive elevations or increases in CA-125, which is one of the reasons why it’s not reliable for ovarian cancer screening. In a patient with a history of ovarian cancer, particularly if their CA-125 was elevated at initial diagnosis, it can be a valuable marker that can aid in following disease. We recognize that some ovarian cancers have minimal or no CA-125 secretion. This appears to be particularly true for the non-serous histologies of ovarian cancer; clear cell, mucinous