MANAGEMENT OF EARLY OVARIAN-CANCER - GERM-CELL AND SEX CORD-STROMAL TUMORS
MANAGEMENT OF EARLY OVARIAN-CANCER - GERM-CELL AND SEX CORD-STROMAL TUMORS
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DOI：
10.1006/gyno.1994.1343
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发表时间：
1994-12-01
影响因子：
4.7
通讯作者：
GERSHENSON, DM
中科院分区：
文献类型：
--
作者：
GERSHENSON, DM
恶性卵巢生殖细胞肿瘤（OGCT）和性索间质肿瘤（OSCST），各占所有卵巢恶性肿瘤的不到5%，比上皮性卵巢癌少见得多。在年轻患者怀疑有OGCT，剖腹手术最初是指诊断和治疗。对于大多数患者，保留对侧卵巢和子宫的单侧输卵管卵巢切除术是合适的。这种手术方法的基础是回顾性研究，显示接受单侧或双侧附件切除术的患者的治愈率相同。没有前瞻性研究比较单侧和双侧附件切除术。手术分期对于确定疾病的范围、判断预后和指导术后处理也很重要。如果在OGCT的初始手术中遇到转移性疾病，建议采用与手术治疗晚期上皮性卵巢癌相同的细胞减灭术原则，在技术可行和安全的情况下切除尽可能多的肿瘤。对于所有OGCT患者，除了那些记录良好的IA期1级纯未成熟畸胎瘤或IA期纯无性细胞瘤，术后化疗。目前推荐的OGCT治疗方案是博莱霉素、依托泊苷和顺铂--这一联合治疗方案对I期疾病的治愈率至少为95%，对晚期疾病的治愈率至少为75%。对于患有转移性无性细胞瘤的患者，化疗具有保留大多数患者生育能力的优点，已取代放疗作为标准治疗。对于OSCST患者，没有标准治疗。手术是目前所有OSCST患者可接受的治疗方法，除了那些患有转移性疾病或具有低分化或异源成分的Sertoli-Leydig细胞肿瘤的患者。目前，基于铂的联合化疗对这些后一种患者有利，但这种方案的活性似乎很低。(C)1994年出版社出版。
Malignant ovarian germ cell tumors (OGCT) and sex cord-stromal tumors (OSCST), each of which account for less than 5% of all ovarian malignancies, are much less common than epithelial ovarian cancer. In young patients suspected of having an OGCT, laparotomy is initially indicated for both diagnosis and treatment. For most patients, unilateral salpingo-oophorectomy with preservation of the contralateral ovary and the uterus is appropriate. The basis for this surgical approach is retrospective studies that show an equivalent cure rate for patients who undergo unilateral or bilateral adnexectomy. No prospective studies have compared unilateral with bilateral adnexectomy. Surgical staging is also important to determine the extent of disease, to determine prognosis, and to guide postoperative management. If metastatic disease is encountered during initial surgery for OGCT, the same principles of cytoreductive surgery that have been applied to surgically manage advanced epithelial ovarian cancer are recommended, with resection of as much tumor as is technically feasible and safe. For all OGCT patients except those with well-documented stage IA grade 1 pure immature teratoma or stage IA pure dysgerminoma, postoperative chemotherapy is indicated. The current recommended regimen for OGCT is bleomycin, etoposide, and cisplatin-a combination that appears to result in at least a 95% cure rate for stage I disease and at least a 75% cure rate for advanced-stage disease. For patients with metastatic dysgerminoma, chemotherapy, which has the advantage of preserving fertility in the majority of patients, has supplanted radiotherapy as standard treatment. For patients with OSCST, no standard therapy exists. Surgery alone is currently acceptable treatment for all patients with OSCST except those who have metastatic disease or Sertoli-Leydig cell tumors with poor differentiation or heterologous elements. Currently, platinum-based combination chemotherapy is favored for these latter patients, but the activity of such regimens appears only modest. (C) 1994 Academic Press, Inc.