akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347.2016.10.2.044-054akusherstvo-293Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРNEOADJUVANT CHEMOTHERAPY FOR EPITHELIAL OVARIAN CANCER. MODERN METHODS AND PATIENTS SELECTION CRITERIAНЕОАДЪЮВАНТНАЯ ХИМИОТЕРАПИЯ РАКА ЯИЧНИКОВ. СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ И КРИТЕРИИ ОТБОРА ПАЦИЕНТОКСолоповаА. Е.SolopovaA. E.

к.м.н., доцент кафедры лучевой диагностики и лучевой терапии лечебного факультета,

ул. Трубецкая, 8, стр. 2, Москва, 119991

docent at the Department of Radiology,

Trubetskaya, 8, str. 2, Moskva, 119991

dr.solopova@mail.ruЧащинА. А.ChashchinA. A.

интерн кафедры акушерства и гинекологии медико-профилактического факультета,

ул. Трубецкая, 8, стр. 2, Москва, 119991

intern of Department of Obstetrics and Gynecology,

Trubetskaya str., 8, p. 1, Moscow, 119991

alexchashchin@gmail.comСолоповаА. Г.SolopovaA. G.

д.м.н.,профессор кафедры акушерства и гинекологии медико-профилактического факультета,

ул. Трубецкая, дом 8, стр. 1, 119991, Москва

MD, Professor of Department of Obstetrics and Gynecology, 

Trubetskaya str., 8, p. 1, Moscow, 119991

antoninasolopova@yandex.ruГуровС. Н.GurovS. N.

к.м.н., заведующий отделением химиотерапии,

ул. Бауманская, д.17/1, Москва, 105005

PhD, Head of the department of chemotherapy,

ul. Baumanskaya, 17/1, Moscow, 105005

МакацарияА. Д.MakatsariyaA. D.

д.м.н., член-корреспондент РАН, профессор, заведующий кафедрой акушерства и гинекологии медико-профилактического факультета

ул. Трубецкая, 8, стр. 2, Москва, 119048

MD, corresponding member of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics and Gynecology, Faculty of Medical and Preventive,

ul. Trubetskaya, 8, str. 2, Moskva, 119048

gemostasis@mail.ruГБОУ ВПО «Первый МГМУ имени И.М. Сеченова» Минздрава РоссииРоссияMedical Sechenov University of the Ministry of Health Russian FederationRussian FederationГБУЗ «Онкологический клинический диспансер №1 Департамента здравоохранения города Москвы»РоссияCancer clinical dispensary №1 Department of Health of MoscowRussian Federation2016020920161024454Copyright © Solopova A.E., Chashchin A.A., Solopova A.G., Gurov S.N., Makatsariya A.D., 20162016Солопова А.Е., Чащин А.А., Солопова А.Г., Гуров С.Н., Макацария А.Д.Solopova A.E., Chashchin A.A., Solopova A.G., Gurov S.N., Makatsariya A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/293

Ovarian cancer is the 3rd most common cancer among women with gynecological neoplasms in Russia, at the same time, it have the highest mortality rate among malignant tumors of the female reproductive system. Because ofvague clinical picture and the lack of effective methods for early detection and screening, more than 60% of cases are diagnosed at stage III-IV, after the spread of tumor beyond the pelvis. Standard treatment for this category of patients includes debulking surgery on the first stage, followed by adjuvant chemotherapy. The main predictor of the prognosis is the residualvolume of disease after debulking surgery. Nowadays, complete resection of all macroscopic disease is considered as optimal cytoreduction. Trying to perform surgical treatment in the optimal volume dictates the need for complex, multi-component operations, accompanied by significant postoperative morbidity and mortality. In addition, in many cases, resection of all macroscopic foci of the disease is technically impossible.The use of neoadjuvant chemotherapy is designed to reduce the incidence of postoperative complications and to achieve optimal cytoreduction in the maximum number of patients.After an analysis of literature the authors could make up aconclusion that the place of neoadjuvant chemotherapy in the treatment of advanced forms of ovarian cancer is still arguable. Based on data from clinical trials, the primary debulking surgery after the diagnosis is the best treatment for this category of patients. However, among patients with markers of unresectability according to the radiologic methods, as well as patients with poor performance status, that significantly increases the risk of surgery, use of neoadjuvant chemotherapy is a reasonable method of choice.

Рак яичников занимает 3-е место в структуре онкогинекологической заболеваемости в России, демонстрируя при этом наиболее высокие показатели летальности среди злокачественных новообразований женской репродуктивной системы. В связи со стертой клинической картиной и отсутствием эффективных методов ранней диагностики и скрининга, а также сложностями дифференциальной оценки более 60% случаев заболевания диагностируются на III-IVстадии, после распространения опухолевого процесса за пределы малого таза. Стандартная схема лечения для данной категории пациенток включает на первом этапе хирургическое вмешательство с последующей адъювантной полихимиотерапией. Основным прогностическим маркером заболевания является остаточный объем опухолевого поражения после проведения циторедуктивной операции, при этом оптимальной считается резекция всех макроскопических очагов заболевания. Попытка проведения хирургического лечения в оптимальном объеме диктует необходимость выполнения сложных, многокомпонентных операций, сопровождающихся высокой послеоперационной морбидностью и летальностью. Кроме того, у значительного количества больных выполнение резекции всех макроскопических очагов заболевания является технически невозможным. Применение неоадъювантной химиотерапии призвано снизить частоту послеоперационных осложнений и добиться оптимальной циторедукции у максимального числа больных. Проведенный авторами анализ литературы позволил сделать вывод, что вопрос о месте неоадъювантной химиотерапии в лечении распространенных форм рака яичников в настоящий момент не может быть решен окончательно. Основываясь на результатах клинических исследований, немедленное выполнение циторедуктивной операции после установки диагноза остается основным методом лечения для данной категории пациенток. Однако среди больных с признаками нерезектабельности процесса, по результатам лучевых методов исследования, а также находящихся в тяжелом состоянии, значительно повышающем риски проведения оперативного лечения, применение неоадъювантной химиотерапии является разумным методом выбора.

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The authors declare that there are no conflicts of interest present.