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Background and purpose: Over 80% of advanced ovarian cancer will recur after primary treatment with a median progression-free survival time of 20 months. Patients with recurrent ovarian cancer can’t be cured, but can achieve longer life span and improved life of quality. This study proposed to design a three-step chemotherapy regimen for firstly relapsed platinum-sensitive ovarian cancer to improve survival outcomes. Methods: From May 2010 to December 2016, 20 patients with platinum-sensitive first relapsed ovarian cancer were treated in the Department of Gynecology and Oncology, Fudan University Shanghai Cancer Center. All patients received three-step chemotherapy. The three-step chemotherapy regimen included: ① paclitaxel+carboplatin, administered once every 3 weeks, a total of 6 cycles; ② nedaplatin+etoposide+cyclophosphamide, administered once every 4 weeks, total 5 cycles followed by paclitaxel+carboplatin, administered once every 4-6 weeks, a total of 4 cycles; ③ nedaplatin+etoposide+ cyclophosphamide, administered once every 8 weeks, a total of 5 cycles. Results: The 4-year disease-free survival (DFS) rate and the 5-year DFS rate were 65.0% (13/20) and 61.5% (8/13), respectively. The 4-year and 5-year survival rates were both 100% (20/20 and 13/13). Conclusion: Three-step chemotherapy regimen is correlated to improved survival outcomes for patients with platinum- sensitive recurrent ovarian cancer. Due to its promising effects and low costs, potential value of this treatment strategy is worth further exploration.

Abstract Background Pelvic lymph nodes metastasis is an important prognostic factor for patients with cervical carcinoma. However, the relationships between the number of positive nodes, site of metastases nodes, adjuvant therapy and the prognosis is controversial. The purpose of this study was to investigate the influence of positive lymph nodes on the prognosis of Chinese women with stage IB1-IIB cervical carcinoma. Patients and methods Between January 1992 and December 1997, 398 women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIB cervical carcinoma underwent radical surgery in Cancer Hospital, Fudan University. Of these sixty-six patients (16.6%) who were histologically confirmed to have positive pelvic lymph nodes were analyzed retrospectively. The survival was estimated using Kaplan-Meier method. The differences in survival were compared with Log-rank test. Multivariate analyses were performed with the Cox proportional hazard model. Results The 5-year survival of the patients with pelvic lymph nodes metastases was 40.7%. Cox proportional hazard model analysis showed that cellular differentiation, the number of positive nodes and adjuvant therapy to be the independent prognostic factors (P < 0.05). The 5-year survival of patients with one positive node was higher than that of those with two or more positive nodes (56.5% vs. 36.4%, P < 0.05). The distant metastasis rate in the former group (5.9%) was lower than the latter's (32.7%) (P = 0.05). However, there was no significant difference of pelvic recurrence between the two groups (P > 0.05). The number of positive nodes positively correlated with the level of positive nodes (P < 0.01). The 5-year survival of the patients who had no adjuvant therapy (12.6%) was much lower than that (53.7%) of those with adjuvant therapy (P < 0.05). However, there was no obvious difference between adjuvant radiotherapy, chemotherapy and chemo-radiotherapy (P > 0.05). Conclusions The prognosis of patients with stage IB1-IIB node-positive cervical carcinoma who underwent radical surgery alone was very poor. Adjuvant therapy increases the survival rate, decreases the pelvic recurrence and distant metastasis.

Dose-dense early postoperative intraperitoneal chemotherapy (DD-EPIC) significantly increased non-progression rate in advanced ovarian cancer (OC) patients. We report final overall survival (OS) results to further strengthen the efficacy of DD-EPIC in the front-line therapy. In this phase 2 trial, 218 patients with FIGO IIIC-IV OC were randomly allocated to receive DD-EPIC followed by intravenous (IV) chemotherapy (DD-EPIC group), or IV chemotherapy alone (IV group). The study was prespecified to detect differences in progression-free survival (PFS) and OS. At a median follow-up period of 69.1 months, the median OS was 67.5 and 46.3 months in the DD-EPIC and IV group, respectively. The probability rate of OS at 5 years was 61.0% with DD-EPIC, and 38.2% with IV (hazard ratio [HR] for death from OC, 0.70; 95% confidence interval [CI], 0.49-1.00). DD-EPIC was associated with a prolonged PFS compared with the IV group (the estimated rate of PFS at 5 years, 26.0% vs. 8.5%; HR for disease progression, 0.64; 95% CI, 0.47-0.86). DD-EPIC was associated with a longer OS than IV chemotherapy alone. It may be considered as a valuable option of the front-line therapy for advanced ovarian cancer.Trial registration: ClinicalTrials.gov, NCT01669226 (date of registration: August 20, 2012). [ABSTRACT FROM AUTHOR]

Background: Pelvic lymph nodes metastasis is an important prognostic factor for patients with cervical carcinoma. However, the relationships between the number of positive nodes, site of metastases nodes, adjuvant therapy and the prognosis is controversial. The purpose of this study was to investigate the influence of positive lymph nodes on the prognosis of Chinese women with stage IB1-IIB cervical carcinoma., Patients and Methods: Between January 1992 and December 1997, 398 women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIB cervical carcinoma underwent radical surgery in Cancer Hospital, Fudan University. Of these sixty-six patients (16.6%) who were histologically confirmed to have positive pelvic lymph nodes were analyzed retrospectively. The survival was estimated using Kaplan-Meier method. The differences in survival were compared with Log-rank test. Multivariate analyses were performed with the Cox proportional hazard model., Results: The 5-year survival of the patients with pelvic lymph nodes metastases was 40.7%. Cox proportional hazard model analysis showed that cellular differentiation, the number of positive nodes and adjuvant therapy to be the independent prognostic factors (P < 0.05). The 5-year survival of patients with one positive node was higher than that of those with two or more positive nodes (56.5% vs. 36.4%, P < 0.05). The distant metastasis rate in the former group (5.9%) was lower than the latter's (32.7%) (P = 0.05). However, there was no significant difference of pelvic recurrence between the two groups (P > 0.05). The number of positive nodes positively correlated with the level of positive nodes (P < 0.01). The 5-year survival of the patients who had no adjuvant therapy (12.6%) was much lower than that (53.7%) of those with adjuvant therapy (P < 0.05). However, there was no obvious difference between adjuvant radiotherapy, chemotherapy and chemo-radiotherapy (P > 0.05)., Conclusions: The prognosis of patients with stage IB1-IIB node-positive cervical carcinoma who underwent radical surgery alone was very poor. Adjuvant therapy increases the survival rate, decreases the pelvic recurrence and distant metastasis.

Objective: To identify variants affecting disease recurrence and clarify the role of re-debulking surgery and second-line chemotherapy in the management of recurrent advanced epithelial ovarian cancer (AEOC)., Methods: One hundred and sixty-seven patients with recurrent AEOC treated in our hospital between Jan. 1986 and Dec. 1997 were retrospectively reviewed. Survival was calculated by Kaplan-Meier method with difference in survival estimated by Log-rank test. Independent prognostic factors were identified by the COX stepwise regression model, and variants associated with disease recurrence were found by logistic stepwise regression methods., Results: The median age was 51 (range 26-71) years. Sixty patients underwent re-debulking surgery, 23 of them with residual disease 1 cm after secondary cytoreduction.

Objective: To study the concentration change of chemotherapeutic agents in plasma and tissue after intraarterial and intravenous injection., Methods: Ten mature female New Zealand rabbits were divided randomly into two groups. Fluorouracil, etopiside, and cisplatin were injected into the rabbits through the ear vein in one group and through the internal iliac artery in the other group. Blood samples and the uterus tissue specimens were collected at various time points after injection. Drug concentration in plasma and tissue was determined by high performance liquid chromatography (HPLC) method. The data were analyzed by the pharmacokinetic program 3P97., Results: Regular concentration change of the three drugs in plasma and tissue was observed after the intravenous and intraarterial injection, which met the two - compartment model. The pharmacokinetic parameters of the three drugs after intravenous and intraarterial injection were different. The peak concentration in plasma after intraarterial injection was lower than that after intravenous injection and the peak concentration and area under curve (AUC) value in tissue after intraarterial injections were higher than those after intravenous injection., Conclusion: Intraarterial chemotherapy has advantages to intravenous chemotherapy in fluorouracil, etopiside and cisplatin. These advantages depend on the drug pharmacological properties.

Objective: To evaluate the effects of combined treatment for advanced epithelial ovarian carcinoma and to analyze its prognostic factors., Methods: Fifty-three patients treated with a three-step combined therapeutic regimen were defined as research arm. The procedures of the three-step combined treatment were as follows: induction of tumor remission, sequential chemotherapy and adjuvant immunotherapy. Three hundred and eighteen patients with advanced epithelial ovarian carcinoma treated with cytoreductive surgery and systemic chemotherapy were retrospectively classified into control arm., Results: The rates of complete response and partial response in the research arm were significantly differed from those in the control arm (90.6%, 5.7% Vs 70.1%, 5.3%, P < 0.01). The 1-, 2- and 3-year survival rates of the research arm and control arm were 97.7%, 89.1%, 83.6% Vs 71.8%, 44.1%, 29.8%, respectively (P < 0.01). The 1-, 2- and 3-year tumor-free survival rates of the research arm and control arm were 92.6%, 75.0%, 75.0% Vs 60.3%, 37.8%, 28.6%, respectively (P < 0.01). The 1- and 2-year recurrent rates of the patients in research arm were much lower than that in control arm (7.5%, 25.0% Vs 39.7%, 62.2%, P < 0.01). Age, stage, ascites, differential degree, preoperative chemotherapy (intraperitoneal and/or intravenous chemotherapy), postoperative intraperitoneal chemotherapy and systemic chemotherapy were poor prognostic factors. Initially treated in other hospital, bilateral tumors, large residuals (diameter more than 1cm) and postoperative intraperitoneal chemotherapy were poor tumor-free survival prognostic factors., Conclusion: Combined therapy including remission induction, consolidation chemotherapy and immunotherapy was able to enhance therapeutic efficacy, decrease the 1- and 2-year recurrent rate and improve the survival of patients with advanced epithelial ovarian carcinoma.

Objective: To study the role of secondary cytoreductive surgery (SCR) in patients with recurrent advanced epithelial ovarian cancer., Methods: From Jan. 1986 to Dec. 1997, 60 women with recurrent advanced epithelial ovarian cancer treated with SCR were retrospectively reviewed. Survival curves were computed using the Kaplan-Meier method with differences in survival estimated by log-rank test. Independent prognostic factors were identified by Cox's stepwise regression, and the affecting factors of SCR evaluated by Logistic stepwise regression., Results: Of the 60 patients, 23 (38.3%) were cytoreduced to small macroscopic residual ( 12 months and without refractory ascites.