卵巣がん化学療法の効果増強のための工夫 : CDDPの有効な投与法, 病理組織型に対応した化学療法レジメンの個別化, 及びネオアジュバント療法の導入 (<シンポジウム>1. 卵巣がん化学療法の基礎と臨床)

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The present study consists of the following 4 sections ; 1) Establishment of new grading system available for all histologic type of ovarian carcinoma, 2) The relationship of histopathologic variables with chemotherapy response and prognosis of patients, 3) The relationship of maximal debulking (MD) with chemotherapy, 4) The clinical approach overcoming platinum-resistance. 1) Authors proposed new grading system based on the architectural grade (glandular : score 1 ; papillary : score 2, solid : score 3), nuclear grade (mild : 1, moderate : 2, marked : 3), and mitotic counts/10 HPF (0-9 : 1, 10-24 : 2, 25≤ : 3). As compared with FIGO grading system based only architectural grade, the new grading system significantly functioned as a prognostic predictor for T3 disease. 2) According to the histologic subtype, ovarian carcinoma could be classified into the following two types, platinum-sensitive disease including serous, transitional cell, and endometrioid carcinoma ; platinum-resistant disease including clear cell and mucinous carcinoma. Thus, the latter two types were considered to be primarily platinum-resistant disease. Histopathologic grade did not affect the response rate to primary platinum-based chemotherapy. However, G3 (high-grade) tumors had a significantly lower CR rate, short duration of progression free interval (PFI), high incidence of progression, and poorer response (47%) to secondary platinumbased regimens, which led to a significantly poorer survival of G3 tumors. The results indicate that more than half of G3 tumors became a secondary platinum resistant disease. 3) For primary-platinum resistant clear cell and mucinous carcinoma, authors designed a combination of CPT-11 and mitomycin with a response rate being approximately 50% for both histologic subtypes with including 2 pathologic CRs. In addition, these types were found to have a significantly high incidence of optimal debulking at the initial surgical attempt as compare with platinum-sensitive disease because of localized dissemination pattern, which suggests a benefit of initial maximal surgical efforts to these histologic types. Clinical approach overcoming acquired platinum-resistant disease included 1) augmentation of 1st line CDDP-based combination including devised dosing mode of CDDP (10mg/m^2, days 1-7) administration, use of doxorubicin for high grade serous and endometrioid ; 2) complete removal of acquired resistant tumors at secondary surgical attempt after 1st line CDDP-based chemotherapy.
社団法人日本産科婦人科学会の論文
1999-08-01

卵巣がん化学療法の効果増強のための工夫 : CDDPの有効な投与法, 病理組織型に対応した化学療法レジメンの個別化, 及びネオアジュバント療法の導入 (<シンポジウム>1. 卵巣がん化学療法の基礎と臨床)

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