胃癌患者术中腹腔热灌注化疗的临床研究

目的：探讨胃癌根治术中一次性腹腔温热灌注化疗的临床疗效。方法：将术中行一次性腹腔温热灌注化疗的50例胃癌患者（治疗组）与未行此方法治疗的100例患者（对照组）的腹腔游离癌细胞检出率及预后等情况进行对比。结果：治疗组的温热灌注液游离癌细胞检出率为7．4％；对照组冲洗液的癌细胞检出率为30．8％。治疗组与对照组术后两年内腹腔复发率分别为14．6％和38．7％（P〈0．01）。治疗组术后1、2、3年生存率分别为100％、79％和60％；对照组则为95．1％、50．2％和35．2％，两组2、3年生存率比较，差异有显著性（P〈0．01）。结论：一次性腹腔温热灌注化疗简便、高效、安全，具有杀灭腹腔游离癌细胞的作用，可降低患者术后腹腔复发率和提高生存率。     

胃癌患者术中腹腔热灌注化疗的临床研究

目的:探讨胃癌根治术中一次性腹腔温热灌注化疗的临床疗效.方法:将术中行一次性腹腔温热灌注化疗的50例胃癌患者(治疗组)与未行此方法治疗的100例患者(对照组)的腹腔游离癌细胞检出率及预后等情况进行对比.结果:治疗组的温热灌注液游离癌细胞检出率为7.4%;对照组冲洗液的癌细胞检出率为30.8%.治疗组与对照组术后两年内腹腔复发率分别为14.6%和38.7%(P＜0.01).治疗组术后1、2、3年生存率分别为100%、79%和60%;对照组则为95.1%、50.2%和35.2%,两组2、3年生存率比较,差异有显著性(P＜0.01).结论:一次性腹腔温热灌注化疗简便、高效、安全,具有杀灭腹腔游离癌细胞的作用,可降低患者术后腹腔复发率和提高生存率.     

进展期胃癌术中腹腔热灌注化疗临床研究

目的探讨进展期胃癌术中腹腔热灌注化疗对防治腹膜转移的疗效及安全性。方法对40例进展期胃癌患者进行回顾性分析,热化疗组(实验组)20例行根治性手术联合术中腹腔热灌注化疗(H IPEC),采用奥沙利铂350 mg溶于右旋糖酐4000 m l中,加热至41.5℃~42.5℃腹腔内循环灌注40~60 m in;选择同期单纯根治性手术治疗的20例胃癌患者作为对照组,对比分析两组患者的临床指标及预后。结果热化疗组仅少数病例治疗后出现短期血压降低、心率增快及肝肾功能、凝血功能指标异常,两组并发症发生率无明显差异;术后腹腔种植转移率热化疗组为5.0%(1/20),对照组15.0%(3/20);1,2年生存率热化疗组分别为90.0%(18/20)和75.0%(15/20),对照组分别为80.0%(16/20)和60.0%(12/20)。结论 H IPEC可有效防治腹膜转移、提高生存率,且并发症少,可作为进展期胃癌术中的辅助治疗。     

Postoperative infections in cytoreductive surgery with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis

BACKGROUND: Peritoneal carcinomatosis is a common evolution of many abdominal and pelvic malignancies. Over the last decade novel therapeutic approaches have emerged combining cytoreductive surgery with perioperative intraperitoneal chemotherapy. Aim of our study was to assess frequency, sites, and organisms of postoperative infections in this surgery and to evaluate associated risk factors and clinical outcome. METHODS: Retrospective study of postoperative infection in 30 patients undergoing combined cytoreductive surgery and hypertermic intraoperative chemotherapy in an oncologic surgery in Rome, between June 2001 and December 2004. RESULTS: Twenty-nine postoperative infections were recorded in 11 patients (36.7%; 2.6 infections per patient), including 13 surgical site infections, 8 clinical sepsis, 6 bloodstream infections, and 2 pneumonias. At multivariate analysis, total peritonectomy was found as independent variable associated to postoperative infection. Mortality rates were 36.4% and 5% among patients with and without postoperative infections, respectively (P = 0.04). Four of the 5 patients with invasive candidosis died. CONCLUSIONS: Peritonectomy procedures have an high risk of postoperative infections, prolonged hospital stay, and high morbidity and mortality. The increasing role of this surgery for the treatment of peritoneal carcinomatosis should strengthen the need for a careful evaluation of possible risk factors for postoperative infections, including the role of colonizing organisms.     

进展期胃癌术中温热灌洗及置泵术后灌注化疗的临床研究

目的探讨进展期胃癌手术切除后腹腔及肝转移的防治方法。方法将282例进展期胃癌切除术后患者分成术中腹腔温热低渗灌洗化疗及术后动脉灌注化疗组169例(简称治疗组)和单纯术后静脉化疗组113例(简称对照组),并对其腹腔转移率、肝转移率及3年生存率进行对照研究。结果治疗组腹腔转移率为21.9%,肝脏转移率12.4%,3年生存率74.6%;对照组腹腔转移率46.0%,肝脏转移率27.4%,3年生存率46.8%。结论术中温热低渗灌洗化疗及术后动脉灌注化疗对进展期胃癌术后腹腔复发和肝转移有良好的防治作用。     

82例进展期胃癌术后腹腔持续温热灌注联合静脉双途径化疗的临床疗效观察

目的　探讨进展期胃癌术后行腹腔持续温热灌注联合静脉的双途径化疗的临床疗效。方法　 82例Ⅱ～Ⅳ期胃癌术后患者随机分为治疗组和对照组。治疗组 4 6例 ,腹腔持续温热灌注联合静脉的双途径化疗 3次 ,常规静脉化疗 3次 ;对照组 36例 ,常规静脉化疗 6次。两组化疗均采用LFAP方案 (甲酰四氢叶酸钙 5 氟脲嘧啶 吡喃阿霉素或米托蒽醌 顺铂 ) ,并均于术后 2 1～ 2 8d开始化疗。结果　治疗组 1,3年生存率分别为 97.8% (45 / 4 6 )和 82 .6 % (38/ 4 6 ) ,对照组分别为 94 .4 %(34/ 36 )和 6 1.1% (2 2 / 36 )。两组 1年生存率差异无显著性 (P >0 .0 5 ) ,3年生存率差异有显著性 (P <0 .0 5 )。治疗组和对照组Ⅱ度以上胃肠道反应发生率分别为 37.0 %和 80 .6 % ,差异有显著性 (P <0 .0 1) ;两组骨髓抑制差异无显著性 (P >0 .0 5 )。结论　双途径化疗可延长Ⅱ～Ⅳ期胃癌术后患者的生存期 ,降低Ⅱ度以上胃肠道反应发生率。     

Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases

The peritoneal cavity must be oncologically considered as an organ in its own right and peritoneal metastases (PM) must be treated with the same curative intent (and the same results) as liver metastases. The package combining complete cytoreductive surgery (CCRS) (treating the visible disease) plus hyperthermic intraoperative peritoneal chemotherapy (HIPEC) (treating the remaining non-visible disease) achieves cure in many patients. Twenty years of publication allow us to assemble sufficient background information and data to point out the good and poor indications for CCRS + HIPEC.HIPEC is the standard of care for the treatment of peritoneal pseudomyxomas and peritoneal mesotheliomas and also, recently for the treatment of colorectal PM with limited peritoneal extension.HIPEC is in the evaluation phase for gastric PM and ovarian PM after initially disappointing results, but it is highly probable that it will be useful in particular settings. PM from neuroendocrine tumours are in the same situation.HIPEC is not currently indicated for the treatment of PM from sarcomas, from GIST, and for small round-cell desmoplastic tumours, given the poor results obtained.HIPEC can be useful, on a case-by-case basis, to treat rare tumours complicated by isolated peritoneal diffusion (e.g. Frantz’s tumours).HIPEC can be used in the prophylactic setting to prevent PM in patients with a high risk of developing PM, and the first results of the ‘second-look’ approach are promising.Finally, CCRS + HIPEC appear to be indispensable tools in the oncologist’s armentarium.     

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treatment of gastric cancer with peritoneal carcinomatosis

Although gastric cancer with peritoneal carcinomatosis is associated with poor prognosis and is generally treated with palliative systemic therapy,recent studies have shown that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may prove to be an efficacious treatnent option.In addition to reviewing the natural history of gastric cancer with peritoneal carcinomatosis,this mini-review examines literature on the efficacy of CRS and HIPEC as compared to chemotherapy and surgical options.Both randomized and nonrandomized studies were summarized with the emphasis focused on overall survival.In summary,CRS and HIPEC are indeed a promising treatment option for gastric cancer with peritoneal carcinomatosis and large randomized clinical trials are warranted.     

Continuous hyperthermic peritoneal perfusion (CHPP) therapy in advanced gastric cancer

In CHPP therapy for advanced gastric cancer, a perfusate containing 20 mg CDDP and 8 mg MMC in 1,000 ml physiologic saline warmed at 47 degrees C was infused at a constant rate of 200 ml/min into the pouch of Douglas. The intraperitoneal temperature at the supra-pancreatic region was around 39.0 degrees C. To obtain a more stable and higher intraperitoneal temperature, the infusing rate was increased to 400 ml/min. This yielded a 3 degrees C higher temperature (42 degrees C) at the same measuring site. However, the temperature recorded at various intraperitoneal sites did not always reach such an effective range. The maximal plasma concentrations of MMC determined during CHPP at the 200 and 400 ml/min infusion were 0.09 +/- 0.03 and 0.11 +/- 0.03 microgram/ml, and those of CDDP 1.6 +/- 0.4 and 1.7 +/- 0.3 microgram/ml, respectively, all of which were not significantly different. When an intraperitoneal dosage of 20 mg MMC was given to 3 patients, the portal venous blood, at 10 min after the administration, produced a 1.7 times higher concentration of the agent than did the peripheral venous blood. This discrepancy between the two concentrations was much smaller than found by other investigators in animal experiments.     

Palliative chemotherapy for advanced gastric cancer.

BACKGROUND: More than two-thirds of patients diagnosed with gastric cancer will have unresectable disease. They present a difficult problem to clinicians as to whether to choose a strictly supportive approach or expose patients to the side-effects of a potentially ineffective treatment. The objective of this article is to review the clinical trials utilizing cytotoxic chemotherapy in patients with advanced gastric cancer. METHODS: A computerized (Medline) search was carried out to identify papers published on this topic between 1966 and 2003. Only articles with an English abstract were reviewed, and studies only presented in abstract form were not included in the analysis. RESULTS: A total of 101 trials were subsequently identified. Four randomized trials compared palliative chemotherapy with best supportive care in 174 patients with advanced gastric cancer. Effectiveness and side-effects were evaluated in 73 phase II studies and 24 randomized phase III trials. CONCLUSION: Analysis of results shows chemotherapy to be superior to best supportive care alone. Combination chemotherapy compared with monochemotherapy is associated with significantly higher overall (complete plus partial) response rates but nevertheless results in similar survival. ECF (epirubicin, cisplatin and 5-fluorouracil) currently represents one of the most effective regimens for advanced gastric cancer, whereas among the newer combinations, irinotecan- or taxane-based regimens have also given promising results. In patients with a poor performance status, consideration could be given to leucovorin-modulated 5-fluorouracil alone. Prognosis for the majority of patients, however, remains poor, as increases in survival were moderate at best.     

进展期胃癌术后腹腔热灌注化疗的研究进展

胃癌为临床常见恶性肿瘤之一, 外科手术是其重要治疗方案, 进展期胃癌患者术后5年生存率较低, 而术后癌灶复发成为影响患者预后的重要因素。随着国内医学水平不断发展, 腹腔热灌注化疗技术得以不断改进, 其在进展期胃癌患者术后辅助治疗中的应用日益广泛, 长期临床实践表明预防性运用腹腔热灌注化疗可明显降低进展期胃癌术后复发率并提高其5年生存率, 在改善患者生存质量及总体临床疗效方面的作用明确。本文旨在对中国进展期胃癌术后腹腔热灌注化疗的临床应用进展进行综述。      

腹腔热灌注化疗治疗结直肠癌腹膜癌

结直肠癌局域性进展可形成腹膜癌，大约10％的患者初诊即发现腹膜癌，有4％～19％的患者在根治术后随访期发生腹膜癌，25％～35％的复发患者以腹膜癌为唯一表现。全身化疗对此类腹膜癌只是姑息性治疗，中位生存期不足6个月。缩瘤术加腹腔热灌注化疗则可清除宏观和微观癌细胞。荷兰癌症中心的Ⅰ、Ⅱ、Ⅲ期临床试验总结分析表明，接受完全缩瘤术加腹腔热灌注化疗者的中位生存期可达42．9个月，1、3、5年生存率分别是95％、56％和43％，明显高于传统治疗方法，已成为英国、法国、意大利、荷兰、西班牙和澳大利亚等国的标准治疗。     

完全肿瘤细胞减灭术加腹腔热灌注化疗治疗胃癌腹膜转移的病例筛选策略

目的:构建肿瘤细胞减灭程度(completeness of cytoreduction,CC)预测模型,为肿瘤细胞减灭术(cytoreductive surgery,CRS)加腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗胃癌腹膜转移(gastric cancer with peritoneal metastasis,GCPM)提供病例筛选方法。方法:比较完全CRS(complete CRS,CCRS)组和不完全CRS(incomplete CRS,ICRS)组患者基本临床病理特征和治疗参数,通过逻辑回归模型筛选CC独立预测因子,精准预测CCRS可能性。结果:125例患者纳入本研究,其中CC0组52例(41.6%),中位总生存期为30.0(95%CI:16.8～43.3)个月;CC1-3组73例,中位总生存期7.3(95%CI:5.7～8.8)个月,差异有统计学意义(P<0.001),而CC1、CC2和CC3组间中位总生存期差异无统计学意义(P>0.05)。因此,CC0定义为CCRS组,CC1-3定义为I...     

Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis

Peritoneal metastasis is the most frequent pattern of gastric cancer recurrence or metastasis and is a definitive determinant of prognosis. However, an effective means of treating peritoneal disease has not yet been established. Systemic chemotherapy has only a limited effect on peritoneal metastasis, although some progress has been shown in terms of median survival time, especially among patients with a minimal or moderate disease burden. Clinical research related to intraperitoneal administration of anticancer drugs is currently underway. An advantage of intraperitoneal chemotherapy is the ability to achieve high concentrations of anticancer drugs in the peritoneal cavity and the direct exposure of peritoneal deposits and free cancer cells to those drugs. In addition, pharmacokinetic studies with taxanes have shown that these high intraperitoneal drug concentrations are sustained for a considerable length of time, allowing prolonged exposure. As taxanes are the most appropriate drugs for intraperitoneal administration, the development of repeated intraperitoneal chemotherapy using taxanes for gastric cancer peritoneal metastasis—either alone or in combination with systemic chemotherapy—has taken place over the past decade, mostly in Japan. Several phase II trials and a phase III trial have recently demonstrated the efficacy of this therapy, including median survival times of 14.4–24.6 months and one-year overall survival rates of 67–91%. These results may lead to the approval of intraperitoneal taxanes, especially paclitaxel, for official insurance coverage in the near future.     

Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis

Peritoneal metastasis is the most frequent pattern of gastric cancer recurrence or metastasis and is a definitive determinant of prognosis. However, an effective means of treating peritoneal disease has not yet been established. Systemic chemotherapy has only a limited effect on peritoneal metastasis, although some progress has been shown in terms of median survival time, especially among patients with a minimal or moderate disease burden. Clinical research related to intraperitoneal administration of anticancer drugs is currently underway. An advantage of intraperitoneal chemotherapy is the ability to achieve high concentrations of anticancer drugs in the peritoneal cavity and the direct exposure of peritoneal deposits and free cancer cells to those drugs. In addition, pharmacokinetic studies with taxanes have shown that these high intraperitoneal drug concentrations are sustained for a considerable length of time, allowing prolonged exposure. As taxanes are the most appropriate drugs for intraperitoneal administration, the development of repeated intraperitoneal chemotherapy using taxanes for gastric cancer peritoneal metastasis—either alone or in combination with systemic chemotherapy—has taken place over the past decade, mostly in Japan. Several phase II trials and a phase III trial have recently demonstrated the efficacy of this therapy, including median survival times of 14.4–24.6 months and one-year overall survival rates of 67–91%. These results may lead to the approval of intraperitoneal taxanes, especially paclitaxel, for official insurance coverage in the near future.

     

Neoadjuvant chemotherapy for gastric cancer with peritoneal dissemination

An early detection and treatment of gastric cancer with peritoneal dissemination are rather difficult so that a clinical trial has been neglected. Therefore, we introduced a pre-operative peritoneal lavage diagnosis for gastric cancer patients with serosa-invaded tumors. Neoadjuvant chemotherapy was introduced to patients with positive cytology and with no non-curative factors except peritoneum. The neoadjuvant chemotherapy followed by surgery was done safely. The patients with the disappearance of CY and P factors due to neoadjuvant chemotherapy had a better prognosis than those with positive results of CY or R However, many of the patients with negative results from peritoneum eventually suffered a peritoneal recurrence. We started another protocol study with S-1 and an intra-peritoneal chemotherapy using docetaxel. The efficacy in the protocol result will be expected.