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Among the 161 cases of pT1 ovarian cancer treated at our hospital during the last 25 years, the impact of systematic lymphadenectomy was evaluated in 93 cases of the pT1N0M0 group(N0 group), 59 cases of the pT1NxM0(Nx group), and 9 cases of the pT1N1M0(N1 group). Significantly greater relapse-free survival(RFS)and overall survival(OS)were observed in 108 cases of the N0+N1 group compared to the Nx group(p=0. 006, p=0. 02). Multivariate analysis showed that systematic lymphadenectomy was a significant prognostic factor(hazard ratio 0. 473(95%CI, 0. 235-0. 951; p=0. 036). The present study suggested the systematic lymphadenectomy had a significant therapeutic effect on pT1 stage ovarian cancers.

Recent reports showed that bevacizumab, a humanized recombinant antibody binding to vascular endothelial growth factor (VEGF), harbored a significant activity in advanced or recurrent epithelial ovarian cancers. However, life-threatening complications including arterial thrombosis, pulmonary hemorrhage, and gastrointestinal perforation (GIP) are not negligible. A Japanese case of bowel perforation associated with bevacizumab treatment in heavily pretreated ovarian cancers is reported. The case affected with refractory ovarian cancer had no signs of bowel obstruction and bowel thickness which are now recognized as risk factors of GIP associated with bevacizumab. After obtaining a written informed consent, a combination of weekly paclitaxel and weekly bevacizumab was administered as the fourth-line therapy. After nine cycles of the regimen, the case developed GIP, although the recurrent tumor showed a stable disease. After conservative therapy for two months, the patient died. The case was severely pretreated; however, there seemed to be no risk factors for GIP. Therefore, we do recommend that special cautions are required for the bevacizumab- based chemotherapy, especially severely pretreated ovarian cancer patients.

Separation of inducing cell differentiation and antiproliferative activities as well as immunoregulatory effects from calcemic activity of the natural hormone, 1alpha,25-dihydroxyvitamin D(3) [1alpha,25 (OH) (2)D(3)] , utilizing the synthetic 1alpha,25 (OH) (2)D(3) analogs has been studied over 20 years. During the past two decades, progress of molecular biology taught us the precise action mechanisms of 1alpha,25 (OH) (2)D(3) through its specific receptor to express the target genes on the molecular level. Modification at the CD-ring side chain of 1alpha,25 (OH) (2)D(3) is the most common chemical conversion, and the alternative approach is A-ring and/or CD-ring modifications. With these chemical functionalizations, some vitamin D analogs are clinically used as medicines or promising candidates for treating secondary hyperparathyroidism, psoriasis, and osteoporosis. Although 1alpha,25 (OH) (2)D(3) can inhibit the growth of various human cancers and regulate the human immune system, primary side effect of 1alpha,25 (OH) (2)D(3) is its tendency to raise serum calcium levels and to cause hypercalcemia, which should be avoided. With these backgrounds, we discuss here recent progress on synthetic vitamin D analogs.

Objective: Recently, paclitaxel (T) and carboplatin (J) combination chemotherapy has been a standard first-line chemotherapy for epithelial ovarian cancer and has improved its prognosis. But we have many chemoresistant cases, and we examined the efficacy of weekly, single-agent, paclitaxel administration., Methods: Seven cases were included in this study. In all cases weekly paclitaxel administration (weekly-T chemotherapy) was performed because of the resistance to pre-treated platinum-based chemotherapy. In all cases the clinical stage was III c, and the histologic types consisted of four serous adenocarcinomas and three clear cell carcinomas. The number of courses and regimens in pre-treated chemotherapy was 8 to 16 (median 9) and 1 to 3 (median 2). Performance status (PS) was more than 2 in four cases. During weekly-T chemotherapy, 80 mg/m2 of paclitaxel was intravenously administered weekyl for 1-hour three times over two weeks, and next administration was performed two weeks later. 2 to 7 (mean 3.9) courses of weekly-T chemotherapy were performed in this study., Results: The treatment outcomes of weekly-T chemotherapy were 2 partial remission (PR), 3 no change (NC) and 2 progressive disease (PD). Though peripheral neuropathy occurred in five cases (71%), the drug for neuropathy needed to be administered in only one case (14%). While the toxicity of hemoglobin was worse than grade 3 in 13 courses (48%), hematological and non-hematological toxicity was mild., Conclusion: The findings suggested that weekly-T chemotherapy was effective for heavily treated ovarian cancer patients in terms of both toxicity and quality of life (QOL).

Shakuyaku-Kanzo-to was first medicated for muscular pain which was called Komuragaeri, and it has been reported that it is effective for peripheral nerve dysfunction such as arthralgia and numbness. Recently, Paclitaxel (T) and Carboplatin (J) combination chemotherapy (TJ chemotherapy) has been a standard first-line chemotherapy for epithelial ovarian carcinoma. For the arthralgia and muscular pain occurring in TJ chemotherapy, non-steroid-anti-inflammatory drugs (NSAIDs), Vitamin B12 (VB12) and Shakuyaku-Kanzo-to are the major medications. In this study, we examined twenty-one cases in which arthralgia and muscular pain occurred in TJ chemotherapy (including 16 cases as first-line chemotherapy). In all cases, patients took 7.5 g of Shakuyaku-Kanzo-to orally per day for eight days. We investigated the efficacy of Shakuyaku-Kanzo-to retrospectively with the following results. In nine cases (43%), Shakuyaku-Kanzo-to was effective in reducing pain. Especially in TJ chemotherapy as first-line chemotherapy, Shakuyaku-Kanzo-to was even more effective in reducing pain. We suggested that Paclitaxel combination chemotherapy with Shakuyaku-Kanzo-to taken orally is a more safe and tolerable way to reduce pain in epithelial ovarian carcinoma.