进展期胃癌术后早期腹腔温热灌注化疗疗效的临床研究

[目的]探讨进展期胃癌术后早期腹腔温热灌注化疗对于改善患者生存率的意义。[方法]159例L3、L4（Ⅱ-Ⅳ期）胃癌手术患者，对比研究腹腔温热化疗组化疗方案（78例）与对照组（81例）术后并发症、复发转移率和3年生存率。[结果]并发症比较：腹腔温热化疗组腹胀及肌酐升高的发生率均显著高于对照组（92.3％vs．14．8％，P〈0．05；11．5％VS．1．2％，P〈0．05），但治疗后均恢复正常。术后复发转移：腹腔温热化疗组腹膜腔复发转移率显著低于对照组（32．1％vs．54-3％，P〈0．05）。腹腔温热化疗组3年生存率显著高于对照组（52．6％VS．32．1％，P=0．003）。[结论]进展期胃癌术后早期进行腹腔温热灌注化疗能够减少腹膜腔复发转移，提高生存率。     

胃癌手术前后腹腔温热化疗的疗效观察

目的为了提高胃癌的切除和生存率,降低化疗的毒副反应。方法对60例胃癌术前患者和100例术后患者进行了腹腔温热化疗,并分组进行比较,结果提高了胃癌患者的手术切除率,提高了术后1、3年生存率,减少了抗癌药物的毒副反应。结论腹腔温热化疗可能是胃癌病人理想的化疗途径化疗方法。     

进展期胃癌术中腹腔温热化疗的疗效研究

目的　探讨术中腹腔温热化疗对进展期胃癌患者的疗效。方法　将同期收治的进展期胃癌患者随机分成腹腔温热化疗组(以下称治疗组 )和对照组 ,治疗组在术中行腹腔温热化疗 ,对照组术后常规静脉途径化疗。对术后患者随诊 ,分析两组患者术后生存率、腹腔复发率。结果　治疗组 1、3、5年生存率分别为 89%、82 %、45 % ;对照组 1、3、5年生存率分别为 77%、5 8%、3 6%。两组差异有显著性 (P <0 0 1)。治疗组腹腔复发率为 6% ;对照组腹腔复发率 2 4%。具有显著性差异 (P <0 0 5 )。两组毒副作用无关差异。结论　术中温热化疗可提高进展期胃癌患者生存率 ,预防腹腔复发 ,有广阔临床应用前景     

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。     

胃癌术后腹腔化疗疗效对比分析及评价

目的:评价胃癌术后腹腔化疗的疗效及其与胃癌生物学行为的相关性。方法:将1996年1月～2000年7月中国医科大学第一附属医院肿瘤科收治的进展期胃癌275例,分为根治切除组和姑息切除或探查组,再分别根据是否进行腹腔化疗分成实验组(128例)与对照组(147例),实验组行温热腹腔化疗,对照组未做腹腔化疗。应用Kaplan-Meier生存曲线分析两组各年生存率的差别,利用字2检验分析腹腔化疗对相同胃癌生物学行为类型病例近期生存率的影响。结果:Kaplan-Meier生存曲线显示腹腔化疗能有效提高胃癌根治性切除病例的1、3年生存率,分别提高13.8%和20.5%,中位生存期延长22个月,即使是生物学行为差的病例,腹腔化疗亦能提高其生存时间。本组晚期胃癌行姑息性切除术后病例的中位生存期提高了8个月,延长了生存时间。结论:腹腔化疗是进展期胃癌手术治疗后有效的辅助疗法。     

腹腔温热化疗研究现状和进展

腹腔温热化疗（IHCP）作为消化道肿瘤根治术后的一种辅助疗法，效果肯定。本文着重介绍了IHCP近几年的研究进展。     

进展期胃癌术中康莱特腹腔温热化疗的临床探讨

胃癌是我国最常见的恶性肿瘤之一．多数患者确诊时已属进展期，虽然胃癌扩大根治术大大改善了患者的预后．但广泛的腹膜种植是其预后相当差的主要原因之一。我科对54例术中发现有腹膜转移的进展期胃癌，分为A(康莱特组)、B(单纯化疗组)两组：A组均在术中给予加热至45℃的康莱特注射液200mL腹腔灌注。经对比观察，A组疗效满意．结果总结报道如下。     

腹腔温热化疗并全身化疗治疗进展期胃癌47例临床观察

 目的 观察腹腔温热化疗并全身化疗治疗进展期胃癌的临床疗效及毒副作用。方法 47例Ⅱ ~ Ⅳ期胃癌患者在术后1个月内先予顺铂80 ~ 100 mg+氟尿嘧啶1 000 mg行腹腔温热灌注化疗（第1天）并全身化疗（亚叶酸钙100 mg静脉滴注第2天~第5天，氟尿嘧啶500 ~ 750 mg静脉滴注第2天~第5天，吡柔比星50 ~ 60 mg静脉推注第2天），连用3周期后改为常规静脉化疗，用药：亚叶酸钙100 mg、氟尿嘧啶750 mg、顺铂20 mg均静脉滴注，连用5 d，吡柔比星50 ~ 60 mg静脉推注第1天，至少治疗3周期。结果 7例Ⅳ期胃癌患者CR４例，PR３例；47例期胃癌患者随访1年生存率97.9 %，2年生存率76.6 %。结论 腹腔温热化疗并全身化疗治疗方法对进展期胃癌术后患者的近期疗效肯定，毒副作用可以耐受，值得临床继续研究。     

手术加腹腔温热灌注化疗治疗进展期胃癌疗效观察

目的：探讨进展期胃癌手术切除后行 43℃顺铂、丝裂霉素溶液腹腔灌注治疗效果。方法：将 64例进展期胃癌患者随机分为灌注组和非灌注组,每组 32例,灌注组用 43℃顺铂,丝裂霉素腹腔灌注化疗作观察组。非灌注组 32例为对照组,并作术后随访 2年的疗效比较。结果：观察组 1、 2年生存率分别为 96.32％、 82.78％,对照组依次为 83.05％、 49.83％,（ P=0.0433）;观察组 1、 2年腹腔转移率分别为 28.12％、 40.62％,对照组为 37.5％、 68.75％,（ P=0.0238）,毒副作用两组比较无明显差异（ P=0.2437）。结论：进展期胃癌手术加腹腔温热灌注化疗可以提高近期疗效。     

胃癌术中低渗温热腹腔化疗联合术后早期腹腔化疗的疗效观察

背景与目的:胃癌脱落细胞引起的腹腔内肿瘤复发是中晚期胃癌患者治疗失败的重要原因,腹腔内化疗可以有效地杀灭腹腔脱落细胞。本研究拟探讨术中即时低渗温热腹腔化疗联合术后早期腹腔化疗的应用价值。方法:156例胃癌患者随机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1组)、单纯术中即时低渗温热腹腔化疗组(治疗2组)和未行腹腔化疗组(对照组)。结果:治疗1组的2年生存率为84.4%,对照组为65.2%,差异有显著性(P<0.05);治疗1组的3年生存率为71.1%,明显高于治疗2组(50.0%)和对照组(45.6%)(P<0.05)。治疗1组肝转移的发生率为7.7%,明显低于对照组(27.3%)(P<0.01);治疗2组肝转移的发生率为10.2%,明显低于对照组(27.3%)(P<0.05)。结论:术中即时低渗温热腹腔化疗联合术后早期腹腔化疗对胃癌有确实的疗效,腹腔化疗对胃癌术后肝转移有确实的预防效果。     

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。     

胃肠肿瘤根治术后腹腔热灌注化疗结合高频热疗序贯静脉化疗与单纯静脉化疗的对比研究

目的:探讨胃肠肿瘤根治术后腹腔热灌注化疗联合高频热疗序贯静脉化疗对比单纯静脉化疗的疗效和安全性.方法:2005年4月-2010年4月接受胃肠肿瘤根治术的52例患者,其中25例于术后接受了腹腔热灌注化疗联合高频热疗序贯静脉化疗(治疗组),另27例接受了单纯静脉化疗(对照组).腹腔热灌注化疗方案为顺铂(100mg/m2)+5-氟尿嘧啶(3g/m2),分成3次剂量,分别于第1、5和9天进行腹腔热灌注化疗.比较2组的不良反应、疾病进展时间和总生存期.结果:治疗组术后1年和40个月的无进展率分别为72.0％和54.0％,中位疾病进展时间为40.1个月;对照组的术后1年和40个月无进展率分别为65.8％和11.5％,中位疾病进展时间为18.5个月.治疗组的中位疾病进展时间较对照组明显延长(P=0.027).治疗组的术后1年和20个月的总生存率分别为88.0％和78.0％;对照组的1年和20个月的总生存率分别为92.6％和72.7％.2组的生存率比较,差异无统计学意义(P=0.108).2组的化疗不良反应和并发症差异也无统计学意义.结论:胃肠肿瘤根治术后行腹腔热灌注化疗联合高频热疗序贯静脉化疗与单纯静脉化疗的不良反应和并发症发生率相似,至疾病进展时间明显延长.     

Hyperthermic intraperitoneal chemotherapy in serosa-invasive gastric cancer patients

BackgroundEvaluation of hyperthermic intraperitoneal chemotherapy (HIPEC) in reducing metachronous peritoneal metastases (MPM) risks in patients with resectable serosa-invasive gastric cancer.Materials & methodsBetween 2008 and 2016, 154 patients with gastric cancer (stage IIB-IIIC) were randomly assigned to two groups: 76 patients underwent HIPEC (cisplatin 50 mg/m² + doxorubicin 50 mg/m², 42 °C, 1 h) combined with radical surgery (HIPEC group) and 78 patients underwent only radical surgery (control group).ResultsEvaluation of HIPEC toxicity showed neither toxic complications of IV-V degree nor haematological toxicity (according to CTCAE v. 4.03). There was no significant difference in the rate of complications between the two groups (p = 0.254). There was a more frequent disease progression in the control group than in the HIPEC group: 42/55 patients (76.4%) vs. 36/68 patients (52.9%), respectively (p = 0.009). At the same time a significant decrease in the rate of MPM was observed after HIPEC administration as compared with surgery alone – 16/68 (12.8%) vs. 39/55 (27.6%) (p < 0.001). 3-year progression-free survival was 47% (95% CI 36–61)) in the HIPEC group and 27% (95% CI 17–43) in the control group – p = 0.0024.The N-stage, HIPEC procedure, type of surgery and interaction between HIPEC treatment and age were independent prognostic factors.ConclusionsHIPEC appears to be helpful in improving treatment results in radically operated gastric cancer patients.     

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。     

Systemic exposure of oxaliplatin and docetaxel in gastric cancer patients with peritonitis carcinomatosis treated with intraperitoneal hyperthermic chemotherapy

In the PERISCOPE I study, gastric cancer patients with limited peritoneal dissemination were treated with systemic chemotherapy followed by (sub)total gastrectomy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with 460 mg/m² hyperthermic oxaliplatin followed by normothermic docetaxel in escalating doses (0, 50, 75 mg/m²). In total, 25 patients completed the study protocol. Plasma samples were collected before the start of the HIPEC procedure, after oxaliplatin washing, after docetaxel washing and the following morning. Median peak plasma concentrations were 5.5110⁻³ mg/ml for oxaliplatin, 89110⁻⁶ mg/ml for docetaxel (dose 50 mg/m²) and 113110⁻⁶ mg/ml for docetacel (dose 75 mg/m2). The following morning median plasma concentrations were 32% and 4% of the measured peak concentrations for oxaliplatin and docetaxel, respectively. For both cytostatic agents, no correlation was found between intraperitoneal fluid concentration and peak plasma concentration. High doses oxaliplatin and docetaxel can be given intraperitoneally without causing potentially toxic systemic concentrations.     

Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections, with intra-operative hyperthermic intra-peritoneal chemotherapy (HIPEC) and/or early postoperative intra-peritoneal chemotherapy (EPIC) to treat the microscopic residual tumor is a new concept. In recent years, promising results have been reported for peritoneal mesothelioma and carcinomatosis of gastrointestinal and gynaecologic origin treated by this combined protocol. However, CRS with HIPEC and/or EPIC is a complex procedure associated with high rates of potentially life-threatening complications. Furthermore, disease progression following comprehensive treatment is not uncommon and represents a relevant cause of treatment failure. The present paper reviews the available information on early postoperative management and long-term follow-up in patients treated with CRS and intraperitoneal chemotherapy. The peculiar clinical and biological alterations that can be expected during an uncomplicated postoperative course, as compared to standard digestive surgery, are discussed. Early recognition and appropriate management of the most common adverse events are addressed, in order to minimize the impact of treatment-related morbidity on survival and quality of life results. Since re-operative surgery with additional HIPEC, has proven to be useful in selected patients with recurrent disease, long-term surveillance aiming at early detection of postoperative disease progression has become a relevant issue. Current results on follow-up investigations are presented.     

Treatment and prevention of peritoneal carcinomatosis from gastric cancer by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Overview and rationale

Peritoneal carcinomatosis (PC) from gastric cancer is a condition with a very bleak prognosis. Most authors consider it to be a terminal disease and recommend palliative therapy only. Multimodal therapeutic approaches to PC have emerged in the last decades, combining cytoreductive surgery (CRS) and peritonectomy procedures with perioperative intraperitoneal chemotherapy (IPEC), including hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC).     

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of ovarian cancer

Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery and maximal regional chemotherapy, has been applied to treat ovarian cancer resulting in long-term survival rates in selected patients. However, the status of HIPEC in ovarian cancer remains an experimental procedure, given the many variables among the data and trials reviewed, to enable us to derive strong conclusions about its role from this overview. In this review we discuss treatment with HIPEC in patients with ovarian cancer and future prospective of its use in clinical setting. HIPEC is an effective tool in the treatment of selected patients with peritoneal carcinomatosis from ovarian cancer. Unfortunately, due to the lack of randomised trials, the evidence of HIPEC is very limited. Future randomised studies are awaited to define the role and clinical impact of HIPEC in ovarian cancer.     

Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of malignant ascites secondary to unresectable peritoneal carcinomatosis from advanced gastric cancer

Aims

To review our experience of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of malignant ascites from advanced gastric cancer in order to discuss benefits, problems and possible indications.

Methods

From June 2000 to May 2003 laparoscopic approach was used to perform HIPEC on five patients affected by malignant ascites secondary to unresectable peritoneal carcinomatosis of gastric origin, in order to associate the benefits of a definitive palliation of ascites with a minimal invasiveness. All patients had ascites related symptoms requiring iterative paracenteses. Intraperitoneal perfusion of mitomycin-C and cisplatin was delivered for 60–90 min with an inflow temperature of 45 °C.

Results

Complete clinical regression of ascites and related symptoms was achieved in all the five patients treated. Intraoperative course was uneventful in all cases. Mean operative time was 181 min. No postoperative deaths, related to the procedure, occurred. Only a case of delayed gastric empting was recorded as a minor postoperative complication.

Conclusions

Laparoscopic HIPEC appears to be a safe and effective procedure to treat debilitating malignant ascites from unresectable peritoneal carcinomatosis.