What is the treatment for ovarian cancer? Is the treatment for ovarian cancer effective?

Ovarian malignant tumors are mainly treated with surgery, supplemented by radiotherapy, chemotherapy and other comprehensive treatments.

(1) Surgical treatment: Removing the tumor as completely as possible during surgery is still the key to successful treatment. Surgical methods are divided into radical surgery and conservative surgery that preserves fertility. The scope of radical surgery includes bilateral adnexa, uterus, omentum, appendectomy and pelvic and retroperitoneal lymph node dissection. For patients with extensive pelvic tumor implantation and metastasis, it is recommended to perform tumor cell reduction surgery as much as possible. Foreign reports show that the complete remission rate of postoperative chemotherapy for patients with complete surgical resection is 83%, and the complete remission rate of postoperative chemotherapy for patients with basically complete resection (residual tumor diameter 2 cm) is 42%.

Postoperative therapy: Patients with stage IA or B grade 1 epithelial adenocarcinoma require no additional treatment. Their 5-year survival rate is not improved by adjuvant therapy. Patients with stage IA or B grade 2 and 3 tumors, as well as stage II patients, require 3 to 6 courses of adjuvant chemotherapy: Taxol plus cisplatin or carboplatin. The 5-year survival rate for stage I patients is 70% to 100%, depending on the grade of the tumor, and for stage II patients it is 50% to 70%.

(2) Laparoscopic surgery: For patients with localized lesions, ovarian resection can be performed under laparoscopy. Laparoscopy can also be used for secondary exploration of ovarian cancer patients. It is relatively safe and accurate, and has a low incidence of surgical complications. The negative rate and recurrence rate of the second exploration are comparable to those of open laparotomy.

(3) Chemotherapy: There is no unified chemotherapy regimen for the treatment of malignant ovarian tumors. The principles are:

① It is better to use large doses intermittently or small doses continuously. The former means taking the medicine for about 1 week per course of treatment, with an interval of about 3 to 4 weeks. This can not only achieve an effective anti-tumor effect, but also help the body eliminate toxicity and restore immune function.

② Combination chemotherapy is more effective than single chemotherapy: In modern times, there is a trend towards combination therapy, but it should be noted that combination chemotherapy has more severe toxic reactions.

③ Based on drug sensitivity tests, selecting sensitive chemotherapy drugs can prolong the patient's survival time.

④ Different chemotherapy plans should be formulated according to tissue types. Each course of treatment is generally 3 to 4 weeks apart, and the specific situation should depend on the patient's physical condition, degree of reaction, blood picture, liver and kidney function, etc. The medication should be used for at least 4 to 6 courses. For patients with advanced or insensitive tumors, the courses should be more, generally 8 to 10 courses in the first year, and reduced to 3 to 4 courses in the second year. Because ovarian tumors spread very early, the lesions cannot be removed in most cases during surgery, and the effect and application of radiotherapy are also very limited. Therefore, systemic chemotherapy is an important auxiliary treatment method. For some advanced patients, the tumor can be reduced after chemotherapy, creating favorable conditions for reoperation.

Patients with stage III or IV disease need 6 courses of paclitaxel and platinum-based treatment. At the beginning of chemotherapy, patients with very small residual tumors and those who had undergone sub-moderate cytoreductive surgery had an average survival of 30 to 40 months versus 12 to 20 months, respectively.

Advanced ovarian cancer often recurs, and the effectiveness of chemotherapy can be estimated by measuring CA125. After chemotherapy, a second laparotomy may be required because about 2/3 of patients in stage III or IV still have residual disease proven by pathology even if they have a satisfactory clinical response to chemotherapy, and the 5-year survival rate is 5% to 40%.

Patients with recurrent or progressive ovarian cancer who have responded to cisplatin before may be given this drug again. Other useful drugs include topotecan, hexamethylmelamine, ifosfamide, doxorubicin, and etoposide.

Most patients with advanced germ cell malignancies or high-risk early-stage disease can be cured with combination chemotherapy, the most commonly used being bleomycin, etoposide, and cisplatin.

Intraperitoneal chemotherapy: Dissolve 100 mg of cisplatin in 200 ml of 0.9% sodium chloride injection, pour it into the abdominal cavity after hysterectomy and before closing the abdomen, and then suture the peritoneum continuously. By increasing the chance of tumor-drug contact, the treatment effect is improved. Intraperitoneal chemotherapy has become an important route of administration for ovarian cancer. In recent years, some authors have sprinkled sustained-release chemotherapy drugs in the residual tumor bed immediately after surgery, which also plays an important role in controlling postoperative tumor recurrence. However, for patients in the middle and late stages, after successful tumor cell reduction surgery, most scholars advocate starting 7 to 10 days after surgery, and some people believe that there is no need to wait 4 to 6 weeks before implementation, mainly because they are worried that chemotherapy will affect postoperative functional recovery and wound healing.

Arterial interventional chemotherapy: In recent years, percutaneous iliac artery aneurysm chemotherapy has been performed on ovarian cancer patients, and good short-term results have been achieved. High-concentration anticancer drugs are directly injected into the tumor blood supply artery, which can increase the drug concentration inside the cancer lesion (8.9 times higher than systemic intravenous administration and 8.6 times higher than intraperitoneal administration). Chemotherapy through the tumor blood supply artery is beneficial to improve the efficacy and shorten the course of treatment. After intra-arterial administration, the drug concentration in peripheral blood during the same period was 0.009 of intravenous administration and 0.27 of intraperitoneal administration. Therefore, the drug concentration in the tumor is high and maintained for a long time during intra-arterial administration, while the systemic toxic side effects are mild, and the symptoms of nausea and vomiting after surgery are significantly less than those of systemic administration. Interventional chemotherapy has high efficacy and few side effects, and patients are willing to accept it, which has broadened the treatment channels for patients with advanced ovarian cancer.

Arterial hyperthermic perfusion chemotherapy: Using the Seldinger technique, bilateral internal iliac artery hyperthermic perfusion chemotherapy was performed through femoral artery puncture. The perfusion drugs were cisplatin 60mg/m2, doxorubicin 30-40mg/m2, mitomycin 10mg/m2, and 5-Fu 500mg/person. After the physiological saline was heated, it was mixed with the drug solution to a temperature of 45-48℃. According to the blood supply of the tumor, it was slowly injected through the bilateral internal iliac arteries for about 20 minutes. The drug dose ratio between the affected side and the healthy side was 2:1. According to the condition, 2-3 times of transcatheter arterial hyperthermic perfusion treatment were performed.

Arterial hyperthermia can reduce tumor stage, increase control of local lesions, improve the prognosis of ovarian cancer, and does not increase late complications. Intra-arterial hyperthermia chemotherapy is significantly better than systemic chemotherapy in controlling local tumors and can improve the survival rate of patients.

(4) Radiotherapy: The radiosensitivity of ovarian malignant tumors varies greatly. Ovarian endodermal sinus tumor, immature teratoma, and embryonal carcinoma are the least sensitive, ovarian epithelial cancer and granulosa cell carcinoma are moderately sensitive, and dysgerminoma is the most sensitive. Radiotherapy after surgery can generally control the disease. Since ovarian cancer metastasizes to the abdominal cavity early, the irradiation range includes the abdominal cavity and pelvic cavity. The liver and kidney areas are protected to avoid radiation damage. The radiation dose for the entire abdominal cavity is 3000cGy to 5000cGy/6 to 8 weeks.

Brachytherapy refers to the intraperitoneal injection of gold (198AU) and phosphorus (32P), which can make the surface of the abdominal cavity reach a dose that is difficult to reach with external irradiation. Due to its limited penetration, it can be used to treat superficial metastases in the abdominal cavity, residual tumors under the microscope, or ruptured stage I tumors during surgery to improve the five-year survival rate. The disadvantage is that the abdominal cavity must be free of adhesions to ensure that the radioactive isotopes are evenly distributed, otherwise it can cause intestinal damage and cause serious consequences. Generally, the amount of 198AU is 120 to 150 millicuries, and the amount of 32P is 10 to 20 millicuries. 125I can also be implanted in the tumor to control tumor growth.

(5) Molecular targeted drugs: Currently, there are OvaRex, R1549 (pemtumomab), Oregovomab and Omnitarg (pertuzumab) that use mucin as target antigen, but their clinical efficacy needs further observation.