胃癌腹腔化疗进展

胃癌是最常见的消化道恶性肿瘤,胃癌手术切除后转移和复发率高。腹腔内化疗作为进展期胃癌的辅助治疗手段已逐渐应用于临床,且因其独特的药代动力学特征而有肯定的疗效。此文从腹腔化疗的药代动力学及临床应用方面概述胃癌腹腔化疗的新进展。     

胃癌腹腔化疗毒副反应的观察和处理

目的 评价胃癌腹腔化疗的毒副反应，并探讨其处理方法。方法 将156例胃癌病人进行随机分组。分为术中即时低渗温热腹腔化疗联合术后早期腹腔化疗组（治疗组），单纯术中即时低渗温热腹腔化疗组（对照组1），未行腹腔化疗组（对照组2），共三组，观察化疗的安全性和毒副反应。结果 治疗组化学性腹膜炎、消化道反应、骨髓抑制和肝功能异常的发生率明显高于两个对照组。结论 应用术中即时，低渗温热腹腔化疗联合术后早期腹腔化疗时化学性腹膜炎的防治不容忽视。     

Selection of chemotherapy for hyperthermic intraperitoneal use in gastric cancer

PurposeSeveral studies have shown the potential benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients. At present the most effective chemotherapeutic regime in HIPEC for gastric cancer is unknown. The aim of this review was to provide a comprehensive overview of chemotherapeutic agents used for HIPEC in gastric cancer.MethodsA literature search was conducted using the PubMed database to identify studies on chemotherapy used for HIPEC in gastric cancer patients.Results and conclusionThe chemotherapeutic regime of choice in HIPEC for gastric cancer has yet to be determined. The wide variety in studies and study parameters, such as chemotherapeutic agents, dosage, patient characteristics, temperature of perfusate, duration of perfusion, carrier solutions, intraperitoneal pressure and open or closed perfusion techniques, warrant more experimental and clinical studies to determine the optimal treatment schedule. A combination of drugs probably results in a more effective treatment.     

Catheterization-associated complications of intraperitoneal chemotherapy in advanced gastric cancer

AIM: To assess the catheterization-associated complications during intraperitoneal chemotherapy (IPCT) for advanced gastric cancer.METHODS: From 1998 to 2002, 80 patients with advanced gastric cancer received a total of 320 courses of IPCT using a large bore central venous catheter and associated complications were analyzed.RESULTS: Catheterization-associated complications occurred in 11 of the 80 patients (13.8%), including abdominal pain caused by catheter in 2 cases (0.63%), insertion failure in 2 cases (0.63%), bowel perforation in 1 case (0.31%) and abdominal pain during chemotherapy in 6 cases (1.88%).No serious complications required surgical intervention.CONCLUSION: IPCT using central venous catheters can be performed safely and simply without severe associated complications.     

Hyperthermic intraperitoneal chemotherapy for gastric and colorectal cancer in Mainland China

AIM:To investigate the current status of peritoneal carcinomatosis(PC) management,as well as the usage of cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) in mainland China.METHODS:A potentially curative therapeutic strategy for selecting patients with PC,known as Techniques,consists of CRS in combination with HIPEC.A systemic search of published works and clinical trials was performed.Additional papers were retrieved by crosschecking references and obtaining information from ...     

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer

Gastric cancer associated peritoneal carcinomatosis(GCPC) has a poor prognosis with a median survival of less than one year. Systemic chemotherapy including targeted agents has not been found to significantly increase the survival in GCPC. Since recurrent gastric cancer remains confined to the abdominal cavity in many patients, regional therapies like aggressive cytoreductive surgery( CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) have been investigated for GCPC. HIPEC has been used for three indications in GC- as an adjuvant therapy after a curative surgery, HIPEC has been shown to improve survival and reduce peritoneal recurrences in many randomised trials in Asian countries; as a definitive treatment in established PC, HIPEC along with CRS is the only therapeutic modality that has resulted in longterm survival in select groups of patients; as a palliative treatment in advanced PC with intractable ascites, HIPEC has been shown to control ascites and reduce the need for frequent paracentesis. While the results of randomised trials of adjuvant HIPEC from western centres are awaited, the role of HIPEC in the treatment of GCPC is still evolving and needs larger studies before it is accepted as a standard of care.     

Selection criteria for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer

Peritoneal carcinomatosis in gastric cancer is associated with a dismal prognosis.Systemic chemotherapy is not effective because of the existence of a blood-peritoneal barrier.Cytoreductive surgery and intraperitoneal chemotherapy can improve survival and quality of life in selected patients.Patient selection for this multimodal approach is one of the most critical issues,and calls for interdisciplinary evaluation by radiologists,medical and surgical oncologists,and anaesthetists.This article sets forth cri...     

进展期胃癌术前冲击化疗联合术中腹腔内温热化疗疗效观察

目的观察术前短程冲击化疗联合术中即时腹腔内温热灌注化疗治疗进展期胃癌的临床疗效。方法136例进展期胃癌随机分术前短程冲击化疗联合术中腹腔内温热灌注化疗组（治疗1组）、术前短程冲击化疗组（治疗2组）和单纯手术组（对照组）,比较三组患者的手术并发症发生率和术后长期生存率。结果治疗1组的3a生存率为88．1％,明显高于治疗2组（68．1％）和对照组（42．6％）（P〈0．05）,治疗1组2a内无复发,治疗2组、对照组复发率为17．0％、38．3％,差异有统计学意义（P〈0．05）。结论进展期胃癌术前短程冲击化疗联合术中即时腹腔内温热灌注化疗能提高患者生存率,延缓肿瘤复发。     

腹腔化疗对老年进展期胃癌患者术后细胞免疫的影响

目的探讨老年胃癌患者手术后腹腔化疗对免疫功能的影响。方法对我院1997年1月至2002年12月60岁及以上接受胃癌根治性手术并进行腹腔化疗的49例患者前后细胞免疫检测,并与我院同期接受胃癌根治性手术并单独行静脉化疗的37例患者进行比较,以健康老年人作为正常对照组。所有患者于化疗前1d和化疗后7d早晨空腹时静脉采血,正常对照组于体检当日早晨空腹时静脉采血,测定血清中NK细胞和T细胞亚群。结果老年胃癌患者手术后CD4 和NK细胞水平明显低于正常对照组;老年胃癌患者化疗后CD4 、CD4 /CD8 和NK细胞水平低于化疗前,静脉化疗组化疗前后的差异具有统计学意义(P<0.05),而腹腔化疗组病人化疗前后的差异无统计学意义(P>0.05)。结论针对老年胃癌患者手术后的免疫特性,宜采用对细胞免疫抑制较轻的腹腔化疗方式进行化疗。     

雷替曲塞用于结直肠癌术中腹腔灌注化疗的近期安全性评估

目的评估雷替曲塞用于结直肠癌患者术中腹腔灌注化疗的近期安全性以及可行性。 方法回顾性分析2017年7月至2018年10月期间就诊于中国医学科学院肿瘤医院结直肠外科并进行手术治疗患者的临床资料,分为研究组和对照组,研究组40例,对照组40例,研究组在关腹后经引流管行雷替曲塞腹腔灌注化疗,对照组用蒸馏水冲洗后关腹。分析两组患者术后并发症发生率、血液学毒性、肝肾功能、胃肠道功能恢复等近期安全性的差异。 结果两组患者术后并发症发生率、血液学毒性、肝肾功能、胃肠道功能恢复时间相比较差异均无统计学意义（均P>0.05）。 结论雷替曲塞用于结直肠癌患者术中灌注化疗具有良好的安全性及耐受性,不增加术后并发症。     

Surgery and adjuvant chemotherapy for gastric cancer

A review has been made of the results of surgical treatment of 8,000 cases of gastric cancer treated at the Cancer Institute Hospital, Tokyo, between 1946 and 1986. Resectability was 89.6%, and operative mortality 1.9%. The five-year survival rate was 37.4% for all cases, 59.4% for patients with curative surgery, and 5.0% for those with non-curative surgery. The curative rate improved more than twofold over 41 years among the patients with curative gastrectomy. No one survived more than five years who had visible tumor left after the surgery. Improvement was attributed to the increase in the incidence of early gastric cancer, and in part to surgery including systemic lymphadenectomy and combined resection of adjacent organs involved by cancer. Extensive intervention might be justifiable to eradicate the tumor when the surgery is curative, or relatively non-curative. Multimodality therapy is needed for the control of advanced cancer.     

不能手术切除晚期胃癌病人介入化疗的疗效观察

目的探讨动脉内介入化疗治疗不能手术切除的晚期胃癌病人的临床疗效和毒副反应.方法对不能手术切除的晚期胃癌60例行动脉内介入化疗者作为对照组.32例行常规静脉滴注化疗者作为对照组.从肿瘤大小变化方面和生存时间方面进行对比观察.结果动脉内介入化疗有效率58.3%,静脉化疗有效率28.1%,平均生存时间、动脉内介入治疗为306d,静脉化疗为72d.两组比较差异有显著性.毒副反应静脉滴注组发生率高,主要为白细胞下降、恶心、呕吐等.结论动脉内介入化疗方法治疗不能切除的晚期胃癌临床疗效优于静脉化疗方法.     

Prognostic significance of intraperitoneal free cancer cells in gastric cancer patients

Summary We performed intraoperative peritoneal cytology in 171 gastric cancer patients undergoing curative surgery. Intraperitoneal free cancer cells were demonstrated in almost all patients in whom the area of serosal cancer invasion exceeded 15–20 cm². In patients with both serosal cancer invasion and free cancer cells the 5-year survival rat was 13% as compared with 85% for patients who had neither, and 40% for patients who had serosal invasion but no free peritoneal cancer cells. Peritoneal metastasis was the most frequently observed recurrence pattern. There-fore, in gastric cancer patients with marked serosal invasion, intraoperative IP administration of cytocidal anticancer drugs should be considered.     

胃癌新辅助化疗的研究进展

目前,进展期胃癌依然是不能治愈的疾病.然而,一些化疗药物在胃癌治疗中的单一及联合应用被证明具有临床意义.总体的单一用药有效率为10%-30%,联合用药有效率为30%-60%.虽然新辅助化疗在胃癌系统治疗中的作用仍为实验性阶段,但是一些Ⅱ、Ⅲ期的临床试验结果值得我们更深一步的研究.本文就对胃癌新辅助化疗作一简要综述.     

Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis

A 68-year-old man underwent laparoscopic low anterior resection for rectal carcinoma in December 2006. Nearly 19 mo after the operation, he developed recurrent rectal cancer with peritoneal metastasis. In September 2008, he subsequently underwent a laparotomy with a peritonectomy, omentectomy, splenectomy, and a Hartmann procedure. Hyperthermic intraperitoneal oxaliplatin 750 mg was administered. The patient was discharged with no postoperative complications and has been well with postoperative FOLFOX chemotherapy.     

Effectiveness of preoperative chemotherapy for far advanced gastric cancer

We herein report a case in which preoperative chemotherapy with cisplatin and 5-fluorouracil was found to effectively treat far advanced gastric cancer invading the pancreas forming a huge mass with regional and distant lymph node metastases. As a result of this treatment regimen, a potentially curative resection was performed which led to a substantially increased survival. The patient was treated with 10 mg of cisplatin and 1000 mg of 5-fluouracil each day preoperatively. After the continuous administration of these drugs for 28 days, the findings of extensive pancreas invasion and lymph node metastases dramatically disappeared. The tumor could be curatively resected by a total gastrectomy with lymph nodes dissection, combined with a distal pancreatectomy and splenectomy. A histological study of a resected specimen showed some cancer cell infiltration remaining within the muscularis propria with fibrous change. There was no evidence of either pancreas invasion or lymph node metastasis. As a result, postoperative adjuvant chemotherapy was performed, 14 months later lymph nodes recurrence was detected and the patient died 20 months after surgery. Our findings suggest that preoperative chemotherapy may thus be effective for the treatment of gastric cancer by both reducing the tumor burden and prolonging survival.     

Fulminant amoebic colitis during chemotherapy for advanced gastric cancer

A 52-year-old man had bloody stools during chemotherapy for gastric cancer. A colonoscopy revealed necrotizing ulcer-like changes. A biopsy confirmed the presence of amoebic trophozoites. Subsequently, peritonitis with intestinal perforation developed, and emergency peritoneal lavage and colostomy were performed. After surgery, endotoxin adsorption therapy was performed and metronidazole was given. Symptoms of peritonitis and colonitis resolved. However, the patient＇s general condition worsened with the progression of gastric cancer. The patient died 50 d after surgery. Fulminant amoebic colitis is very rarely associated with chemotherapy. Amoebic colitis should be considered in the differential diagnosis of patients who have bloody stools during chemotherapy.     

Neoadjuvant chemotherapy for advanced gastric cancer: a meta-analysis

AIM:To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.METHODS:All published controlled trials of NAC for advanced gastric cancer vs no therapy before surgery were searched.Studies that included patients with metastases at enrollment were excluded.Databases included Cochrane Library of Clinical Comparative Trials,MEDLINE,Embase,and American Society of Clinical Oncology meeting abstracts from 1978 to 2010.The censor date was...