羟基喜树碱冻干粉针+顺铂腹腔化疗联合TACE在中晚期肝癌中的临床应用

目的：评价羟基喜树碱冻干粉针（HCPT）＋顺铂（DDP）腹腔灌注联合肝动脉栓塞化疗术（TACE）在中晚期肝癌患者中的临床疗效。方法：肝癌患者按住院先后随机分为：治疗组48例：腹腔化疗：HCPT30mg＋DDP60mg，第二天行TACE；对照组45例：采用单纯TACE治疗。两方案均是每50天1周期，每例至少化疗2周期。结果：治疗组总有效率62．5％，生活质量改善率72．92％，AFP下降率70．0％，中位生存期11．5个月。对照组总有效率31．11％，生活质量改善率35．56％，AFP下降率34．21％，中位生存期8．2个月，两组比较，差异有显著性（P〈0．05）。结论：羟基喜树碱冻干粉针＋顺铂腹腔化疗联合TACE对中晚期肝癌患者是一种安全、有效的治疗方法。     

紫杉醇周方案联合顺铂腹腔热灌注化疗治疗51例晚期胃癌

背景与目的：目前认为紫杉醇、顺铂（DDP）对晚期胃癌疗效肯定，毒副反应可以耐受。且近年来大量研究证实腹腔热灌注化疗对消化道癌有确切临床疗效。本研究目的为评价紫杉醇周方案给药联合顺铂腹腔热灌注化疗治疗晚期胃癌的近期疗效与毒副反应。方法：51例晚期胃癌患者随机分为全身化疗组（25例），用紫杉醇70mg／m^2，iv，每周1次，共8周，DDP25mg／m^2，iv，第1—3天，每3周重复，共用4个周期；联合腹腔热灌注化疗（CHPP）组（26例），紫杉醇给药方法同前，DDP60mg／m^2，CHPP，第1、8、22、29天，该组患者化疗期间均予腹部热疗2次／周。结果：有效率（CR＋PR）、临床受益率（CBR）联合CHPP组分别为65．4％，92．3％，全身化疗组为36．0％，68．0％，差异有显著性（P〈0．05）；疾病进展时间及中位生存期联合化疗组分别为6．9个月，12．1个月，全身化疗组为5．6个月，10．8个月，差异无显著性（P〉0．05）；主要不良反应为骨髓抑制、恶心／呕吐，两组各项不良反应差异无显著性。结论：紫杉醇周方案给药联合顺铂腹腔热灌注化疗治疗晚期胃癌近期疗效好，不良反应可以耐受，值得进一步研究。     

高剂量亚叶酸钙、氟尿嘧啶与草酸铂治疗晚期难治性结直肠癌

目的：研究高剂量亚叶酸钙（CF）、氟尿嘧啶（5－FU）与草酸铂（OXA）二周方案治疗晚期难治性结直肠癌的临床疗效。方法：采用高剂量CF、5－FU、OXA深静脉输注方案，化疗方案以14天为1周期，重复4周期后间隔1个月评定疗效。结果：全组28例，总有效率为39．28％。直肠癌和结肠癌的有效率分别分33．33％（4／12）和43．13％（7／16）。缓解期为2－24个月，中位缓解期为5．0个月。全组病例、PR病例、治疗无效病例的中位生存期分别为7．0个月，11．0个月，7．0个月。PR病例的中位生存期明显好于无效病例（P＜0．05）。Ⅱ、Ⅲ度口腔炎发生率为21．44％，5例出现手足综合征（手足脱皮、肢端麻木、皮肤色素沉着），血液学毒性轻微。结论：高剂量CF、5－FU、OXA二周方案是治疗晚期难治性结直肠癌有效安全的化疗方案。     

胃体贲门癌全胃切除术后腹腔热灌注化疗160例

目的探讨胃体贲门癌全胃切除术后腹腔热灌注化疗联合全身化疗对腹腔内复发或转移的影响。方法304例胃癌术后患者随机分为两组：治疗组（160例）应用腹腔热灌注化疗,即卡铂（CBP）0．2g／m^2＋丝裂霉素6mg／m^2＋5-氟尿嘧啶（5-Fu）1．0g／m^2＋斑螫酸钠维生素跣1．0mg／m^2＋0．9％氯化钠注射液1500～2000ml（40℃～44℃）＋地塞米松10mg＋利多卡因20mg,热灌注化疗后加用辅助静脉化疗。对照组（144例）仅做辅助静脉化疗,两组4周为1个化疗周期,均实行4～6个周期。结果1、3、5年生存率分别为：治疗组83．8％、56．2％、39．4％,对照组80．6％、45．1％、29．9％,两组比较差异有统计学意义;5年中肝转移率、腹腔转移率、腹腔积液发生率,治疗组分别是30．0％、21．9％、30．0％,对照组分别为38．2％、36．1％、35．4％,两组比较差异有统计学意义;两组化疗的毒副作用比较差异无统计学意义。结论胃体贲门癌全胃切除术后腹腔热灌注化疗是提高胃癌术后患者生存率的有效措施。     

腹腔热灌注化疗联合内生场热疗治疗复发性卵巢癌的临床观察

目的评估腹腔热灌注化疗联合内生场热疗对晚期复发性卵巢癌的疗效。方法22例晚期复发卵巢癌患者注入预热的氯化钠溶液（NS）＋顺铂（DDP）＋依托泊苷（VP16）,同时采用NRL-002内生场热疗机热疗60—120min,每周热灌注化疗1次,单纯热疗1次。结果总有效率（CR＋PR）63．6％,CA125明显下降,CD4／CD8比值及NK细胞数较治疗前升高,临床受益反应81．8％,中位疾病进展时间（MTTP）及中位生存时间（MST）分别为7．8个月和18．5个月。结论腹腔热灌注化疗联合内生场热疗治疗晚期复发性卵巢癌疗效确切,能改善患者的生活质量,不良反应轻,值得临床推广。     

进展期结直肠癌术后腹腔热灌注化疗联合静脉化疗的临床研究

目的观察和比较腹腔热灌注化疗联合静脉化疗与单纯静脉化疗对进展期大肠癌术后腹腔局部复发、肝转移率及3年生存率的影响和不良反应。方法将90例大肠癌根治术后的进展期结直肠癌患者随机分成腹腔热灌注化疗联合静脉化疗组（治疗组）和静脉化疗组（对照组）,比较其疗效和生存率。结果治疗组3年腹腔局部复发率、肝转移率及3年生存率分别为15．6％、8．9％、82．2％,而对照组为37．8％、26．7％、62．2％,差异均有统计学意义（P〈0．05）,两组不良反应差异无统计学意义（P〉0．05）。结论影响进展期大肠癌术后生存率的主要原因是癌细胞的肝转移和腹腔局部复发,而腹腔热灌注化疗联合静脉化疗是预防进展期大肠癌术后肝转移和腹腔局部复发非常有效的方法。     

大剂量他莫昔芬逆转晚期结肠癌多药耐药性的临床研究

目的：研究大剂量他莫昔芬（tamoxifen，TAM）逆转晚期结肠癌经氟尿嘧啶一草酸铂化疗方案产生的耐药性的作用。方法：挑选外周血淋巴细胞P—gp表达阳性并接受多次化疗的晚期结肠癌患者59例，随机分成两组。A组（31例）应用大剂量TAM（100mg，2次／d，5d）逆转耐药治疗后，行氟尿嘧啶＋草酸铂方案化疗；B组（28例）仅完成上述化疗。结果：A组有效率为25．8％（8／31），均为PR，无CR，生存时间9～82周，中位生存期为10．31个月，1年生存率为32．3％（10／31）；B组有效率为0（0／28），生存时间7～63周，中位生存期为5．67个月，1年生存率为10．7％（3／28）。A组P-gp转阴率为32．3％（10／31），B组为0（0／28）。A组的总有效率及P-gp转阴率与B组间差异有统计学意义，P1=0．0067，P2=0．0043。两组的毒副反应均较轻，两组间差异无统计学意义。结论：大剂量TAM对P-gp阳性的结肠癌多药耐药性有一定的逆转作用，临床应用可提高这部分患者的化疗敏感性。     

紫杉醇或草酸铂联合氟脲嘧啶/亚叶酸治疗晚期胃癌的对比研究

目的：观察并比较紫杉醇联合氟脲嘧啶／亚叶酸（5-FU／CF）与草酸铂联合5-FU／CF治疗晚期胃癌的疗效及毒副反应：方法：随机将晚期胃癌患者分为两组：紫杉醇联合5-FU／CF组（A组）27倒．草酸铂联合5-FU／CF（B组）29例．每例患者至少完成2周期以上的化疗。结果：A组有效率（CR＋PR）为59．26％，中位缓解期5．8个月，中位生存期11．6个月、B组有效率（CR＋PR）为55．17％，中位缓解期6．2个月，中位生存期10．8个月。两组的主要毒副反应为骨髓抑制、神经毒性和消化道反应。两者相比A组的骨髓抑制、脱发较重．B组轻度腹泻的发生率稍高。结论：紫杉醇联合5-FU／CF与草酸铂联合5-FU／CF两方案治疗晚期胃癌疗效相当，毒副反应均可耐受。     

含紫杉醇类和卡铂的不同方案治疗卵巢癌临床分析

目的：观察紫杉醇联合卡铂经静脉、腹腔联合治疗卵巢癌的疗效及毒副作用。方法：27例卵巢上皮癌患者分为4组：A1组，泰素、卡铂静脉推注（5例）；A2组，泰素静脉推注、卡铂腹腔滴注（7例）；B1组，紫杉醇、卡铂静脉推注（6例）；B2组紫杉醇静脉推注、卡铂腹腔化疗（9例）。观察每次化疗后的毒副作用，完成4个疗程后观察疗效。结果：27例中25例完成4个疗程，2例出现过敏性休克而中止化疗。总有效率A1组60％（3／5）；A2组71．4％（5／7）；B1组50％（3／6）；B2组66．7％（6／9）。毒副反应比较，泰素组与紫杉醇组间及腹腔静脉联合化疗组与静脉化疗组间差异均有显著性（P〈0．05）。结论：紫杉醇类与卡铂联合化疗对卵巢癌有一定疗效，腹腔静脉联合化疗毒副作用低于单纯静脉化疗，泰素组心脏毒性低于紫杉醇组。     

GP和FP治疗转移性鼻咽癌的疗效观察

目的：观察吉西他滨＋顺铂（GP）方案和氟尿嘧啶＋顺铂（FP）方案治疗晚期复发转移性鼻咽癌的疗效及不良反应。方法：选择放疗后复发转移性鼻咽癌60例,分别采用GP方案或FP方案静脉化疗,21天为1周期。结果：GP组：CR5例、PR19例,有效率（CR＋PR）80％;FP组：CR2例、PR14例,有效率（CR＋PR）53．3％两组有效率有显著差异（P=0．0283）。中位PFS（无进展生存期）GP组8个月,FP组3个月（P=0．0001）。中位OS期（总生存期）GP组11个月,FP组7个月（P=0．0002）。两组毒性均能耐受。结论：GP方案较FP可以更好改善复发转移性鼻咽癌的RR、PFS和OS。     

Efficacy of intraperitoneal chemohyperthermia with oxaliplatin in colorectal peritoneal carcinomatosis. Preliminary results in 24 patients.

BACKGROUND: The complete resection of macroscopic colorectal peritoneal carcinomatosis (PC), followed by intraoperative intraperitoneal chemohyperthermia (IPCH) to treat residual microscopic disease, leads to cure in some patients. We report preliminary results on survival in a phase II study using oxaliplatin (LOHP). PATIENTS AND METHODS: Twenty-four patients with macroscopic colorectal PC underwent complete resection of the PC followed by IPCH with LOHP performed in an open abdominal cavity. The dose of LOHP was 460 mg/m(2) in 2 l/m(2), during 30 min at 43 degrees C, at a flow rate of 2 l/min. During the hour preceding IPCH, they received an intravenous administration of 5-fluorouracil (400 mg/m(2)) and leucovorin (20 mg/m(2)). RESULTS: Mean peritoneal tumoral extension (Sugarbaker's Index) was 16.9 +/- 9.5, median operative duration was 490 min and median blood loss was 965 ml. There were two postoperative deaths (8%) by intracerebral hemorrhage, and morbidity rate was 41.6%. Minimal follow-up was 18 months and median follow-up was 27.4 months (range 18.3-49.6). At 1, 2 and 3 years, overall survival rates were 83%, 74% and 65%, and disease-free survival rates were 70%, 50% and 50%, respectively. Only 32% of the 22 postoperative living patients presented a peritoneal recurrence. A peritoneal index >24 influenced survival, with a 17% recurrence rate at 2 years versus 63% when it was <24 (P = 0.005). CONCLUSION: This new modality of treatment, when feasible, gives encouraging preliminary results, with a promising 3-year survival rate of 65%.     

Heated intra-operative intraperitoneal oxaliplatin alone and in combination with intraperitoneal irinotecan: Pharmacologic studies.

The results of four prospective clinical trials testing intraperitoneal chemohyperthermia (IPCH) are reported. The first one aimed at determining the appropriate dose of heated (42 degrees C) intraperitoneal oxaliplatin following complete resection of peritoneal carcinomatosis (PC) by studying its pharmacokinetics. The recommended dosage was set at 460 mg/m2 in 2 l/m2 of peritoneal instillation. The second trial is a phase 2 study on 24 patients with colorectal PC treated with the preceding regimen: the 2-year survival rate was 74% after a minimal follow-up of 18 months. A second pharmacokinetic study using intraperitoneal oxaliplatin at the same dose but in hypotonic solutions did not show any survival advantage and was associated with an increase in complications. A third pharmacokinetic study was to determine the appropriate dose of intraperitoneal oxaliplatin combined with intraperitoneal irinotecan: the recommended dosage was 360 mg/m2 for each of the chemotherapy agents.     

Human pharmacokinetic study of heated intraperitoneal oxaliplatin in increasingly hypotonic solutions after complete resection of peritoneal carcinomatosis

Purpose: We studied the pharmacokinetics of heated intraoperative intraperitoneal (i.p.) oxaliplatin (LOHP) solution and its safety profile in increasingly hypotonic solutions. This is the first clinical study of i.p. chemohyperthermia with hypotonic solutions. Methods: Patients with peritoneal carcinomatosis (PC) underwent complete cytoreductive surgery followed by intraoperative i.p. chemohyperthermia (IPCH) with successive dextrose solutions of 300, 200, 150 and 100 mosm/l. LOHP (460 mg/m(2)) was administered in 2 liters of solution/m(2) at an i.p. temperature of 42-44 degrees C for 30 min. IPCH was performed using an open procedure (skin pulled upwards) with a continuous closed circuit. Patients received intravenous leucovorin (20 mg/m(2)) and 5-fluorouracil (400 mg/m(2)) just before IPCH to maximize the effect of LOHP. i.p. plasma and tissue samples were analyzed by means of atomic absorption spectrophotometry. Sixteen consecutive patients with PC of either gastrointestinal or peritoneal origin were treated. The safety of the procedure was studied. Results: Pharmacokinetics: The mean duration of the entire procedure was 7.7 +/- 2.6 h. Half the LOHP dose was absorbed within 30 min at all dose levels. Absorption was not higher with hypotonic solutions than with isotonic solutions. The area under the curve of LOHP in plasma did not increase with decreasing osmolarity of the i.p. solutions. Intratumoral LOHP penetration was high; it was similar to that at the peritoneal surface, and about 18 times higher than that in nonbathed tissues. LOHP penetration was not significantly increased by using hypotonic solutions. Safety: There was a very high incidence of unexplained postoperative peritoneal bleeding (50%) and unusually severe thrombocytopenia in the 150 and 100 mosm/l groups. Conclusion: Contrary to experimental studies, this clinical study showed no increase in tumoral or systemic penetration of LOHP with i.p. hypotonic solutions (200, 150 or 100 mosm/l) during IPCH. A high incidence of i.p. hemorrhage and thrombocytopenia was observed.     

Intraperitoneal chemohyperthermia: rationale, technique, indications, and results

Intraperitoneal chemohyperthermia (IPCH) is a loco-regional treatment for intraperitoneal malignancies. This ultra-radical treatment combines complete cytoreduction of macroscopic peritoneal disease preceding perioperative intraperitoneal perfusion of a chemotherapeutic drug heated to 42 degrees to 44 degrees to treat microscopic residual disease. At present time, this approach is mainly indicated for isolated limited peritoneal carcinomatosis (PC) of colorectal origin and for treatment of low-grade pseudomyxoma peritonei. In selected patients, IPCH may lead to 27% five-year overall survival in cases of PC, and as high as 86% five-year survival in cases of pseudomyxoma peritonei. In the near future, this approach will become the standard treatment for selected cases of PC.     

Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis

BACKGROUND: Most patients with peritoneal carcinomatosis of digestive tract origin die within 6 months. Intraperitoneal chemohyperthermia (IPCH) associated with surgery has been reported as a possible new therapeutic approach. METHODS: A prospective Phase II trial was carried out with 83 patients who had digestive tract cancer and peritoneal carcinomatosis to evaluate the tolerance and efficacy of IPCH with mitomycin C (MMC) associated with surgery. Eighty-six IPCH treatments with MMC were given as complementary therapy after surgery (peritoneal perfusate with a 10 mg/L dose of MMC; inflow temperature, 46-49 degrees C; use of a closed circuit; duration, 90 minutes). Primary tumors were mainly gastric (in 42 cases) or colorectal (in 27 cases). RESULTS: Mortality and morbidity occurred in 3 of 83 cases and 8 of 83 cases, respectively. For patients with resectable tumors, the median survival time was 16 months when carcinomatosis was Stage I and II (malignant granulations less than 5 mm in greatest dimension), whereas it was 6 months when carcinomatosis was Stage III and IV (malignant granulations more than 5 mm in greatest dimension). For patients with resectable gastric cancer and Stage I and II carcinomatosis, 1-, 2-, and 3-year actuarial survival rates were 80%, 61%, and 41%, respectively, whereas the rate was 10% at 1 year for patients with bulky disease (Stage III and IV). CONCLUSIONS: IPCH appears to be a promising new approach to treating patients with digestive tract cancers and peritoneal carcinomatosis with small, malignant granulations (Stage I and II).     

Heated intra-operative intraperitoneal oxaliplatin after complete resection of peritoneal carcinomatosis: pharmacokinetics and tissue distribution.

PURPOSE: This article reports the pharmacokinetics (PK) of heated intra-operative intraperitoneal oxaliplatin and its tolerance profile. Oxaliplatin has demonstrated significant activity in advanced colorectal cancer, and this is the first publication concerning its intraperitoneal administration. METHODS: Twenty consecutive patients with peritoneal carcinomatosis (PC) of either gastrointestinal or uniquely peritoneal origin underwent complete cytoreductive surgery followed by intra-operative intraperitoneal chemo-hyperthermia (IPCH) with increasing doses of oxaliplatin. We performed IPCH using an open procedure (skin pulled upwards), at an intraperitoneal temperature of 42-44 degrees C, with 2 l/m2 of 5% dextrose instillate in a closed circuit. The flow-rate was 2 l/min for 30 min. Patients received intravenous leucovorin (20 mg/m2) and 5-fluorouracil (400 mg/m2) just before the IPCH to maximize the effect of oxaliplatin. We treated at least three patients at each of the six intraperitoneal oxaliplatin dose levels (from 260 to 460 mg/m2) before progressing to the next. We analysed intraperitoneal, plasma and tissue samples with atomic absorption spectrophotometry. RESULTS: The mean duration of the entire procedure was 8.4 +/- 2.7 h. Half the oxaliplatin dose was absorbed in 30 min at all dose levels. Area under the curve (AUC) and maximal plasma concentration (Cmax) increased with dose. At the highest dose level (460 mg/m2), peritoneal oxaliplatin concentration was 25-fold that in plasma. AUCs following intraperitoneal administration were consistently inferior to historical control AUCs after intravenous oxaliplatin (130 mg/m2). Intratumoral oxaliplatin penetration was high, similar to absorption at the peritoneal surface and 17.8-fold higher than that in non-bathed tissues. Increasing instillate volume to 2.5 l/m2 instead of 2 l/m2 dramatically decreased oxaliplatin concentration and absorption. There were no deaths, nor severe haematological, renal or neurological toxicity, but we observed two fistulas and three deep abscesses. CONCLUSIONS: Heated intraperitoneal chemotherapy gives high peritoneal and tumour oxaliplatin concentrations with limited systemic absorption. We recommend an oxaliplatin dose of 460 mg/m2 in 2 l/m2 of 5% dextrose for intraperitoneal chemo-hyperthermia, at a temperature of 42-44 degrees C over 30 min. We may be able to improve these results by increasing the intraperitoneal perfusion duration or by modifying the instillate composition.     

Treatment of peritoneal carcinomatosis in patients with digestive cancers with combination of intraperitoneal hyperthermia and mitomycin C

Peritoneal carcinomatosis in patients with digestive cancer carries a poor prognosis, with a majority of patients dying within 6 months. Mitomycin C has been reported to have some antitumor efficacy in this setting. We performed combination intraperitoneal hyperthermia and mitomycin to potentiate the effect of mitomycin C in 83 patients with peritoneal involvement due to digestive cancers. Eighty six IPCH procedures were performed using inflow temperature 46 to 49 degrees Celsius, using a closed circuit, during 90 minutes. Mitomycin C was administered as a perfusate at 10 mg/l. Primary tumors were essentially gastric (42) and colorectal (27). Mortality and morbidity rates were 3/83 and 5/83 respectively. For resectable tumors, the median survival time was 16 months in stage 1 and 2 carcinomatosis (malignant granulations less than 5 mm in diameter). For resectable gastric cancers with stage 1 and 2 carcinomatosis, one, two and three year actuarial survival rates were 80, 61 and 41% respectively. In conclusion, IPCH appears to be an interesting therapeutic option in patients with digestive cancers and small malignant peritoneal granulations (stage 1 and 2).     

Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy.

BACKGROUND: Peritoneal carcinomatosis (PC) is fatal, despite standard systemic chemotherapy. A new approach that combines maximal surgery with maximal regional chemotherapy has potential to cure selected patients who have colorectal PC. The authors have reported the oncologic results of this combined treatment. METHODS: The authors performed a retrospective study of 64 patients who had PC arising from colorectal adenocarcinomas, 19 (29.6%) of whom also had other metastases. These patients were treated by complete resection of all detectable tumors and by a 5-day course of early intraperitoneal chemotherapy (EPIC) with mitomycin C, then by 5-fluorouracil (n = 37), or by intraoperative intraperitoneal chemohyperthermia (IPCH) with mitomycin C, alone or combined with cisplatin (n = 27), in 2 separate trials. In the trial of IPCH, aimed at selecting the most reliable procedure in terms of spatial diffusion and thermal homogeneity, the 27 patients were treated with 7 different procedures. The extent of PC was assessed precisely by using a peritoneal index. The median follow-up period for the entire patient population was 51.7 months. RESULTS: The postoperative mortality and morbidity rates were 9.3% and 54.6%, respectively. Most severe complications occurred in patients who required extensive cytoreductive surgery. Global and disease-free survival rates were respectively 60.1% and 54.7% at 2 years and were 27.4% and 18.4% at 5 years. Results were significantly better (P = 0.04) when patients were metastasis-free (apart from PC) and when the peritoneal index was lower than 16 (P = 0.005). IPCH seemed to be more effective than EPIC for treatment of PC. CONCLUSION: This treatment plan, which combined maximal surgery with maximal regional chemotherapy, cured approximately 25% of patients. This strategy was mainly applicable to patients with limited intraperitoneal cancer volume and no extraperitoneal involvement. IPCH proved to be more effective than EPIC but more difficult to use correctly. Future results should improve through routine use of the optimal hyperthermia procedure, with improvements in the composition of instillate, better patient selection, and the reduction in the rate of complications that occurs with physician experience.     

Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia

Peritoneal carcinomatosis is a common manifestation of digestive-tract cancer and has been regarded a terminal disease with a short median survival. Over the past decade, a new locoregional therapeutic approach combining cytoreductive surgery with intraperitoneal chemohyperthermia (IPCH) has evolved. Because of its limited benefits, high morbidity and mortality, and high cost, this comprehensive management plan requires accurate patient selection. Quantitative prognostic indicators are needed to assess a patient's eligibility for combined treatment, including tumour histopathology, classification of carcinomatosis extent, assessment of completeness of cytoreduction, and determination of the extent of previous surgery. Patients with pseudomyxoma peritonei and those with peritoneal dissemination of digestive-tract cancer have shown promising survival. Complete cytoreduction with no visible disease persisting is a requirement for long-term benefit. In Japan and Korea, use of IPCH as prophylactic treatment in potentially curative gastric-cancer resection has shown improved survival and lower peritoneal recurrence rates. IPCH combined with cytoreductive surgery seems to be an effective therapeutic approach in carefully selected patients, and offers a chance for cure or palliation in this condition with few alternative treatment options.     

Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study.

PURPOSE: The three principal studies dedicated to the natural history of peritoneal carcinomatosis (PC) from colorectal cancer consistently showed median survival ranging between 6 and 8 months. New approaches combining cytoreductive surgery and perioperative intraperitoneal chemotherapy suggest improved survival. PATIENTS AND METHODS: A retrospective multicenter study was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy). PC from appendiceal origin was excluded. RESULTS: The study included 506 patients from 28 institutions operated between May 1987 and December 2002. Their median age was 51 years. The median follow-up was 53 months. The morbidity and mortality rates were 22.9% and 4%, respectively. The overall median survival was 19.2 months. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months, compared with 8.4 months for patients in whom complete cytoreductive surgery was not possible (P <.001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis, and poor histologic differentiation were negative independent prognostic indicators. CONCLUSION: The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.