ARCHIVEOBSTETRICS AND GYNECOLOGY
International Medical Journal, Vol. 21., Iss. 3, 2015, P. 21−25.
WAYS OF IMPROVING THE RESULTS OF TREATMENT OF ADVANCED FORMS OF OVARIAN CANCER
S. P. Grigoriev Institute for Medical Radiology, Ukraine
Ovarian cancer (OC) takes the4th place in the structure of oncological diseases of the female reproductive system. One−year survival of ovarian cancer patients is 63 %, three year −− 41 %, five−year −− 35 %. In Ukraine the incidence of ovarian cancer is 16.4 per 100,000 population and death rate is 9.8 per 100 000 population. At present the questions about the optimal sequence of treatments for patients with ovarian cancer with the aim of improving of disease−free and overall survival are investigated. In patients with advanced ovarian cancer neoadjuvant chemotherapy (NCT) can improve the resectability of the tumor, increase the frequency of optimal cytoreductive surgery. Objective effect of NCT in OC reaches 71.6 %. Replacement of cyclophosphamide to paclitaxel in standard combination with cisplatin significantly improved the immediate and remote results of treatment of patients with disseminated ovarian cancer: increased frequency of objective response from 66 to 77 %, disease−free survival from 12.0 to 16.6 months, the average life expectancy from 25 to 35 months. The use of pre− and postoperative intraperitoneal chemotherapy is strongly proposed. Determination of molecular−biological markers (MBM) in the tumor tissue may provide additional information about the biological behavior of the tumor: the rate of its growth, ability to invade and metastasize, resistance to chemotherapy. Prognostic values of markers of apoptosis, angiogenesis, proliferation and other for relapse−free and overall survival of patients are actively studied. A new dynamic analysis of drug resistance and sensitivity in anticancer therapy is provided. However, the most important MBM to predict the course current of the disease and choice of therapy have not been defined. The solution of these problems will lead to individualization of cancer treatment. Introduction to oncology practice of minimally invasive endoscopic technique could contribute the improvement of results of treatment of patients with OC. The procedure allows morphological verification of the tumor, determining the local prevalence and distant metastases in the abdominal cavity, choice of the right tactics of treatment. According to various authors, laparoscopy is preferred over laparotomy in view of the more rapid implementation and the possibility of early beginning of NCT. Laparoscopy allows prediction of resectability with negative predictive value of 100 % and a positive predictive index of 87 %. Cytotoxicity of modern anticancer chemotherapy with its lack of efficacy in many cases and the high price of drugs demonstrates the feasibility of developing new approaches to drug treatment of cancer patients. One of them may be the use of drugs in midget doses (MD) providing their «election» damaging effect on the tumor while maintaining the efficiency that can reduce toxic effects and significant economic effect. Thus, development of new procedures for diagnosis and treatment of ovarian cancer, especially in its advanced forms, based on the study of molecular−biological properties of the tumor, obtained by the application of diagnostic laparoscopy, as well as the introduction of nanotechnology in the creation of anticancer drugs will improve the results of its treatment.
Key words: ovarian cancer, surgical treatment, laparoscopy, molecular biological markers, chemotherapy.