Since the vast majority of tumors can be diagnosed in the early stage and are sensitive to chemotherapy even in the late stage, these malignant ovarian germ cell tumors usually have a good prognosis. Some retrospective studies have shown that the 5-year survival rate of platinum-based chemotherapy is 95%-97%, and most patients are diagnosed with stage I tumors. Studies by Lai and colleagues have shown a 5-year survival rate of 88 per cent for stage I~IV tumors or even tumors with spread.
Recurrent tumors can be treated with chemotherapy, radiotherapy, surgery or combined treatment. If the patients are followed up only after operation, BEP chemotherapy is recommended after recurrence. Radiotherapy, high-dose chemotherapy (etoposide and cisplatin), bone marrow transplantation or POMB-ACE (cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide and etoposide) are available for patients with persistent or recurrent tumors after BEP chemotherapy. Recently, a phase II study showed that paclitaxel and gemcitabine were effective in the treatment of heavily pretreated, recurrent germ cell tumors with an effective rate of 31% (12.5% for lasting complete remission).The long-term follow-up after tumor treatment should not only understand the recurrence of the disease, but also pay attention to the secondary side effects of chemotherapy: the risk of infertility and secondary malignant tumor. Many retrospective reviews showed that ovarian function recovered well after combined chemotherapy. A study shows that 61.7% of women may have amenorrhea when receiving chemotherapy. 91.5% ~ 100% of women can resume menstruation after chemotherapy.Since the number of women who try to conceive after treatment is not clear, the effect of chemotherapy on reproductive function cannot be accurately predicted. One study counted 38 women who tried to conceive after chemotherapy, of which 29 had a successful pregnancy (76%). In addition, a more recent study reported a similar pregnancy success rate (75%). The long-term risk of tumor combination chemotherapy is related to alkylating agents such as etoposide, and the risk is proportional to the dose. A study included 616 children who received alkylating agents in the treatment of germ cell tumors, and the results showed that the 10-year incidence of treatment-related acute leukemia was 1% in patients who received chemotherapy alone, and in children who received combined chemotherapy and radiotherapy. The critical dose of etoposide is 2000mg/m2, and exceeding this dose has the same risk of leukemia as radiotherapy and chemotherapy.Ovarian cancer ranks first among the related morbidity and mortality of gynecological cancer in developed countries. This book includes contributions from senior experts in the clinical management of ovarian cancer as well as in basic research science and frontier disciplines. Although the epidemiological study of ovarian cancer has been relatively perfect, further research will help us to understand the molecular and genetic basis of the disease. These research developments will enable us to: 1 identify women who are vulnerable to ovarian cancer; 2 develop more effective disease prevention strategies. Imaging is an important part of the detection, diagnosis, management and post-treatment monitoring of ovarian cancer.A large number of imaging methods can be used in clinic, and a large number of new techniques, especially molecular imaging, are being developed to detect early diseases and to determine the extent of tumor metastasis in advanced patients. This information is essential for the development of effective surgical plans and adjuvant treatment plans.As described in this book, the purpose of the first operation for advanced ovarian cancer is to establish a correct diagnosis and to use a variety of tumor cell reduction surgical techniques and methods to basically clear the focus. Chemotherapy for patients with advanced ovarian cancer can increase the survival time of patients with advanced ovarian cancer. New therapeutic drugs and their production mechanisms have been integrated into routine clinical practice.Although much progress has been made in early examination and major treatment, a considerable number of women with ovarian cancer will eventually relapse. The latest evidence suggests that repeated tumor cell reduction surgery and successful tumor resection can prolong clinically significant survival time for a selected group of patients. Second-line adjuvant therapy needs to be supported by evidence and selected according to clinical guidelines, such as the interval of treatment, the type of previous treatment, and previous medication. The role of chemoresistance and chemosensitivity tests in the treatment of recurrent diseases needs to be further determined. A large number of encouraging therapeutic drugs, including angiogenesis inhibitors, are now in clinical trials and may eventually be effective in the treatment of primary and recurrent ovarian cancer.In the coming period of time, the improvement of early detection and management of ovarian cancer will depend on more forward-looking scientific discoveries and more effective, less toxic treatments. It is also important to establish a multidisciplinary clinical treatment team, including gynecology, medical oncology, radiology, intensive care, pharmacy, genetic science, nursing, community work and psychiatry, to provide optimal treatment, and ultimately achieve a bumper harvest of prolonging survival time and improving the quality of life.
