Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press48210.17650/1994-4098-2016-12-1-85-93GYNECOLOGY. TREATMENTГИНЕКОЛОГИЯ. ЛЕЧЕНИЕSpecific features of current intraperitoneal therapy in patients with ovarian cancerОсобенности современной внутрибрюшинной терапии у больных раком яичниковKedrovaA. G.КедроваА. Г.
Russian Federation
kedrova.anna@gmail.comLevakovS. A.ЛеваковС. А.
Russian Federation
Krasil’nikovS. E.КрасильниковС. Э.
Russian Federation
MaksimenkoT. A.МаксименкоТ. А.
Russian Federation
VoznesenskiyV. I.ВознесенскийВ. И.
Russian Federation
GerasimovA. V.ГерасимовА. В.
Russian Federation
AstakhovD. A.АстаховД. А.
Russian Federation
KosyyV. V.КосыйВ. В.
Russian Federation
NechaevaO. E.НечаеваО. Е.
Russian Federation
Department of Oncology, Federal Research and Clinical Center for Specialized Medical Cares and Medical Technologies, Federal Biomedical Agency of RussiaОнкологическое отделение ФГБУ «ФНКЦ специализированных видов медицинской помощи и медицинских технологий» ФМБА России28 Orekhovyy Boulevard, Moscow, 115682, Russia Department of Obstetrics and Gynecology, Institute for Advanced Training, Federal Biomedical Agency of RussiaРоссия, 115682, Москва, Ореховый бульвар, 28 кафедра акушерства и гинекологии ФГБОУ ДПО ИПК ФМБА России91 Volokolamskoe Shosse, Moscow, 125371, RussiaРоссия, 125371, Москва, Волоколамское шоссе, 91Department of Obstetrics and Gynecology, Institute for Advanced Training, Federal Biomedical Agency of Russiaкафедра акушерства и гинекологии ФГБОУ ДПО ИПК ФМБА РоссииDepartment of Gynecologic Oncology, Novosibirsk Regional Clinical Oncology Dispensaryонкогинекологическое отделение ГБУЗ НСО «Новосибирский областной клинический онкологический диспансер»2 Plakhotnogo St., Novosibirsk, 630108, RussiaРоссия, 630108, Новосибирск, ул. Плахотного, 2Department of Gynecologic Oncology, Altay Territorial Oncology Dispensaryотделение онкогинекологии КГБУЗ «Алтайский краевой онкологический диспансер»77 Nikitina St., Barnaul, 656049, RussiaРоссия, 656049, Барнаул, ул. Никитина, 77Oncology Department No 3, City Clinical Hospital No 57, Moscow Healthcare Department3-е онкологическое отделение ГБУЗ г. Москвы «Городская клиническая больница № 57 Департамента здравоохранения г. Москвы»32 11th Parkovaya St., Moscow, 105077, RussiaРоссия, 105077, Москва, ул. 11-я Парковая, 3228 Orekhovyy Boulevard, Moscow, 115682, RussiaРоссия, 115682, Москва, Ореховый бульвар, 280606201612185930606201606062016https://ojrs.abvpress.ru/ojrs/article/view/482

Background. Today there are 3 trends in favor of intraperitoneal (IP) chemotherapy: maintenance of its potential 5- and 10-year survival benefit in patients with ovarian cancer (OC); advantages of the IP administration of drugs even after nonoptimal surgery; enhancement of the efficiency of chemotherapy irrespective of the number of IP treatment cycles. There is also an expanded list of possible IP medicines and incorporation of novel targeted drugs into treatment regimens. However, the long-expected data of the most recent randomized trial GOG 0252 have proven deplorable and led to the activation of discussions on the role of IP therapy.

Objective: to generalize the experience of 4 oncology departments with IP therapy in patients with disseminated OC and to compare the findings with those obtained by the world’s leading medical centers.

Materials and methods. The retrospective analysis included 76 patients with Stage IIIC OC who had received IP chemotherapy in accordance with 3 regimens. For standardization of IP treatment procedures, the investigators assessed the following indicators: age; tumor morphological type; surgical radicality; catheter model and port placement procedure; drug administration route; number of treatment cycles; efficiency of therapy from expert ultrasonographic findings and CA-124, HE4, CA-19.9 marker levels, time to disease progression. The analysis also involved adverse manifestations, methods of their correction and the reasons for early treatment discontinuation were separately reported. The obtained data were processed using standard statistical programs.

Results. 55 of the 76 patients could complete more than 4 IP therapy cycles. Among them, only 4 patients were observed to have disease progression at follow-ups lasting over 24 months.

Conclusion. Current IP therapy is a safe and convenient drug treatment in patients with OC after optimal cytoreductive surgery. The mastery and standardization of the procedures for surgery and placement of current IP Celsite® Peritoneal and Celsite® Drainaport devices make it possible to minimize adverse manifestations and to perform all planned therapy cycles in necessary mode, by giving 50 % of the optimally operated patients with OC (Stage IIIC) the chance to have a long-term progression-free survival that is over 2 years, as shown by our observations.

Введение. Сегодня прослеживаются 3 тенденции в пользу внутрибрюшинной (в / б) химиотерапии: сохранение потенциального преимущества в 5- и 10-летней выживаемости у больных раком яичников (РЯ); получение выгоды от в / б введения химиопрепаратов даже после неоптимальных операций; повышение эффективности химиотерапии независимо от числа выполненных курсов в / б лечения. Также происходит расширение перечня лекарственных средств с возможностью в / б введения и включение в схемы терапии новых таргетных препаратов. Однако долгожданные данные последнего рандомизированного исследования GOG 0252 оказались неутешительными и привели к активизации дискуссий о роли в / б терапии.

Цель работы – обобщить опыт 4 онкологических отделений по проведению в / б терапии у больных распространенными формами РЯ и сопоставить полученные данные с мировой практикой ведущих медицинских центров.

Материалы и методы. В ретроспективный анализ включены 76 больных РЯ IIIС стадии, получавших в / б химиотерапию по 3 схемам. Для стандартизации методик в / б лечения оценивали следующие параметры: возраст пациентки, морфологический тип опухоли, радикальность операции, модель катетера и методику установки порта, схему введения препаратов, число выполненных курсов лечения, эффективность терапии по данным экспертного ультразвукового исследования и уровней маркеров СА-125, HE4, СА-19.9, время до прогрессирования болезни. Также в анализ включены побочные проявления, методы их коррекции и отдельно отмечены причины досрочного прекращения лечения. Полученные данные обработаны с помощью стандартных статистических программ.

Результаты. Более 4 курсов в / б терапии смогли завершить 55 из 76 больных. Среди них только у 4 пациенток отмечено прогрессирование болезни при сроках наблюдения более 24 мес.

Выводы. Современная в / б терапия является безопасным и удобным методом лекарственного лечения больных РЯ после оптимальных циторедуктивных операций. Овладение и стандартизация методик хирургии и установки современных в / б портов Celsite® Peritoneal, Celsite® Drainaport позволяет минимизировать побочные проявления и выполнять все запланированные курсы терапии в необходимом режиме, продлевая у 50 % оптимально оперированных больных РЯ (IIIС стадия) период без прогрессирования болезни, по нашим наблюдениям он составляет более 2 лет.

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