| 1 Background and ObjectiveOvarian cancer is one of the female genital system malignant tumor and the mortality rate ranks first year under, because of ovarian malignant tumor often insidious onset, rapid progress, resulting in the about 70%- 80% of ovarian malignant tumors were found in the late stage. The incidence of ovarian malignant tumor in gynecological common tumor in ninth, and its mortality rate ranks fifth. The international standard of ovarian cancer therapy for standardized surgical staging, tumor cell reduction cytoreductive surgery, postoperative combined with paclitaxel plus platinum drugs based first-line chemotherapy, nevertheless, ovarian cancer five years survival rate continues to hover around 40%. So to find a can effectively prevent ovarian malignant tumor surgery after recurrence and improve long-term outcomes of patients and control advanced cancer peritoneal metastasis and ascites elimination, alleviate the symptoms of treatment is still the treatment of malignant tumors of the ovary focus and hot. Chemotherapy of intraperitoneal hyperthermic perfusion(hyperthermic intraperitoneal chemotherapy HIPEC) is in recent years emerging a for the treatment of abdominal malignant tumor means, using high temperature, chemotherapy on tumor cell killing effect, high temperature and chemotherapy drug synergistic effect and perfusion fluid of free tumor cells flushing action, reduce tumor recurrence and metastasis. At present, it is mainly used in the treatment of malignant tumor of digestive tract and has achieved good results. In the treatment of ovarian cancer, it has been reported that intraperitoneal perfusion chemotherapy can improve the survival time of patients in 5 years. Epithelial ovarian cancer(ovarian cancer epithelial, EOC) is the most common in all primary malignant ovarian tumors, accounting for about 90% of ovarian cancer. Mucinous carcinoma of the ovary to EOC sub type, accounting for primary ovarian cancer 12.2~19.9%. It originated from epithelial tissue, mucus secretion hyperthyroidism is characterized, the surface can be neutral or acidic mucus secretion, prognosis compared with other malignant epithelial tumors. Mucus is the main component of mucin. It has a large number of tufted glycoprotein, through its own maintain ability and molecular ion water, disulfide bonds form a network structure and provide the function of gel, thus play the role of barrier protection. Due to the decrease of the concentration of the drug, the enhancement of the detoxification drugs and the ability of DNA repair, the reaction rate of ovarian mucinous carcinoma was lower than that of other epithelial ovarian cancer. This paper will explore the high precision intraperitoneal sustained circulating perfusion chemotherapy combined with intravenous chemotherapy(intravenous chemotherapy, IC) the treatment of mucinous ovarian cancer clinical curative effect.2 Materials and methods2.1 The tissuesOvarian mucinous carcinoma cancer incidence rate is low and intraperitoneal hyperthermic perfusion costs more expensive, this study according to the patient’s personal wishes and the specific situation of the non randomized concurrent control experiment(non-radomized concurrent control trial) group. Was 20 years old is less than or equal to age less than or equal to 75 years old; postoperative pathologically confirmed ovarian mucinous carcinoma; satisfaction of ovarian cancer cells reduced operation destroyer; surgical pathological staging for patients with stage II III. Exclusion criteria: patients who had ovarian tumor cell reduction surgery; coagulation function severe disorder; end of the end of a distant metastasis; age is too high, the merger has a serious disease in the Department of internal medicine can not line HIPEC. Operating personnel are trained by a unified, data entry by two personnel. Sample size calculation(single group rate and baseline rate): the 3 year survival rate of CRS+IC was about 46%, and the 3 year survival rate of CRS+HIPEC+IC was about 81%. To test the level of alpha =0.05, beta =0.1, calculated the experimental group sample size of 18. Select the March June 2013, 2015 in our hospital for diagnosis and treatment has been satisfactory tumor cell cytoreductive surgery(residual lesion < 1cm) and pathological study confirmed type 32 mucinous cystadenocarcinoma of ovary cancer patients. The experimental group was divided into two groups: the control group, the control group and the intraperitoneal perfusion chemotherapy combined with intravenous chemotherapy group.2.2 Statistical analysisTwo groups of patients were first satisfied with ovarian cancer and ovarian tumor cell reduction surgery(residual lesion < 1cm) treatment, the experimental group immediately placed four pelvic cavity perfusion tube. Two groups of patients were given chemotherapy in liver, antiemetic, nutrition and other symptomatic treatment. Experimental group:(1) satisfactory tumor cytoreduction postoperative immediately placed four pelvic and abdominal cavity perfusion tube, two by abdominal percutaneous catheter and pelvic floor on both sides of the head is arranged in the tube; two by abdominal percutaneous placed tube, pipe head is arranged in the subdiaphragmatic liver and spleen region, about 3cm from the liver and spleen. Perfusion method solution: normal saline 3500ml; speed: 400 m L/min, temperature: 43 C constant temperature; continuous perfusion for 1 hours. Perfusion time: first days after operation, third days and fifth days, a total of three times. The chemotherapy dose: first days: third days: Cisplatin cisplatin 90mg; 60mg; fifth days: Cisplatin 60mg; perfusion method. Keep the 1000-1500 ml reperfusion first, 2 times after intraperitoneal perfusion, andclip intraperitoneal chemotherapy tube after 12 hours of opening. After the third perfusion, the abdominal cavity was retained 1000ml perfusion solution and injected into the 60 mg cisplatin, and the injection was induced after 24 hours. The pinch will change the posture of patients with recurrent period. Before infusion to patients were injected with Rhonin 1mg and intravenous diazepam 2 mg, to relieve the discomfort of patients, ECG monitoring vital signs of patients with continuous perfusion, perfusion process pay close attention to the perfusion is smooth, timely adjustment of the direction of the entrance of the perfusion tube, and to observe whether the patient has abdominal distension and other discomfort. The end of the peritoneal perfusion after treatment with intravenous chemotherapy rest 2 weeks "TP" scheme. The chemotherapy drug paclitaxel:135-175mg/m2; oxaliplatin: 130mg/m2; interval of 21 days, a total of 6 times.Control group: Satisfaction with ovarian cancer tumor cells after the rest of the rest 7-10 days that began to carry out the 6 "TP" program of intravenous chemotherapy. Method and experimental group.2.3 The indicatorsThe experimental group and the control group were in preoperative time, intravenous chemotherapy before operation and during the follow-up after leaving blood samples were taken, by chemical luminescent method for the detection of CA125, CA199(CA125 is greater than 35U/ml, CA199 than 27U/ml abnormal) to evaluate the efficacy; ultrasound, CT and MRI detection methodology has no ascites, pelvic and abdominal mass. 1 month after the end of the end of the patients in the experimental group in the tumor cell reduction surgery, 3 times of intraperitoneal hyperthermic perfusion and 6 times of intravenous chemotherapy, patients in the control group in tumor cell reduction surgery and 6 times intravenous chemotherapy end after 1 month were left from peripheral venous blood samples were detected with flow cytometry measured lymphocyte subsets, understanding in patients with immune status(CD4 / CD8 in the human body normal value is about 1.4-2.0). Every time before and after treatment the blood routine, liver and kidney function, twelve lead ECG to understand the toxicity of chemotherapy. The side effects of chemotherapy judgment according to the World Health Organization anticancer chemotherapy toxicity grading criteria for divided into 0 ~ IV degree. If there are patients with II grade and more adverse reactions, the need for symptomatic treatment.2.4 statistical methods:All data are used SPSS17.0 statistical software for processing, the experimental group and the control group data were analysis by t-test, chi square test was used for quantitative data analysis, P < 0.05 when the difference is statistically significant.3 Results3.1 Short term efficacy evaluation3.1.1 plasma CA-125 half-life: experimental group t 20 days in 2 cases, T < 20 days in 17 cases, effective rate was 89.47%; control group t 20 days 4 cases, T < 20 days 7 cases, have efficiency 53.85%. The experimental group was higher than the control group, the difference was statistically significant( P<0.05).3.1.2 3 months after the end of treatment CA-199 decreased to normal comparison: the experimental group was elevated 14, 10 in the control group; 3 months after the end of treatment CA-199 decreased to normal comparison: the experimental group of 13 people, 5 people in the control group. The CA-199 in the experimental group was lower than that in the control group, the difference was statistically significant(P < 0.05)3.1.3 Experimental group complete remission in 7 cases, partial remission in 8 cases, stable in 3 cases, progress in 1 cases; control group complete remission, partial remission, stable, progress of the patients were 2 cases, 4 cases, 4 cases, 3 cases. The effective rate of the experimental group was 78.95%, the effective rate of the experimental group was 46.15% higher than that of the control group, the difference was statistically significant(P<0.05)3.1.4 side effectsToxic side effects According to the WHO anti tumor drug adverse reaction grading standards for the two groups of treatment of the toxic and side effects. In the experimental group and control group two groups of poisonous deputy reaction were mainly manifested in around the gastrointestinal tract reaction, neurotoxicity, bone marrow suppression, but in addition to the gastrointestinal tract reaction in the experimental group compared with the control group, the incidence rate is high. More than differences in the adverse reactions were not statistically significant(P > 0.05).3.2 The immune status of the patientsThe CD4/CD8 ratio of the lymphocyte subsets.There was no significant difference in CD4/CD8 ratio between the two groups after the operation. All the end of treatment after 1 month review, the experimental group decreased 2 people, and after their difference was not statistically significant(P > 0.05); the control group decreased 1 people, and after their difference was not statistically significant(P > 0.05), the difference between the two groups of patients with no statistical significance(P > 0.05).3.3 Followed up for half a year During follow-upAccording to the criteria of 2012 NCCN ovarian cancer recurrence, platinum based chemotherapy achieved clinical remission, 6 months after the cessation of chemotherapy in patients with recurrence. There were 2 cases in the experimental group and 3 cases in the control group, the recurrence rate was 10.53%, the recurrence rate of the control group was 23.08%, P > 0.05, the difference was not statistically significant.4 Conclusion4.1 Hyperthermic intraperitoneal chemotherapy combined with intravenous chemotherapy in the treatment of ovarian mucinous carcinoma of the short-term effect than simple intravenous chemotherapy;4.2 Hyperthermic intraperitoneal chemotherapy combined with intravenous chemotherapy and intravenous chemotherapy alone compared, aggravate the gastrointestinal adverse reaction;4.3 Hyperthermic intraperitoneal chemotherapy combined with intravenous chemotherapy for patients with underlying immune status without obvious effect. |
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