腹腔热灌注化疗的研究进展

腹膜是腹腔恶性肿瘤的常见转移部位,腹膜表面的血液供应很少,加之血浆-腹膜屏障的存在,使得静脉化疗药物很难到达腹膜表面.腹腔热灌注化疗则可直接作用于腹膜,从而有效地治疗腹膜转移癌及其引起的恶性腹水.本文将不同的腹腔热灌注化疗方法进行了分类,并综述了近几年腹腔热灌注化疗的研究进展.     

结直肠癌腹膜转移的多学科综合治疗

腹膜转移是结直肠癌常见转移部位之一,传统观念认为其预后差,没有手术治疗的价值。近年来,随着外科技术、精确控温的腹腔热灌注化疗以及多学科综合治疗的进步,对结直肠癌腹膜转移的认识和治疗策略发生很大的变化,拟就这一问题进行综述。在预后方面,如果仅行姑息性化疗,结直肠癌腹膜转移的预后差于肝、肺等非腹膜部位的转移;但对于一部分合适的患者施行完全性腹膜减瘤术联合腹腔热灌注化疗,则可能使部分患者获得长期生存;腹膜转移癌的预后因素包括腹膜播散癌指数、减瘤术完全性程度、是否合并腹膜外转移(肝脏等)、腹膜表面疾病严重程度评分和日本腹膜分期等。在治疗方面,完全性腹膜减瘤术联合腹腔热灌注化疗以及全身治疗(化疗+靶向治疗),可能是最佳的多学科综合治疗策略。     

胃肠道肿瘤腹膜转移治疗进展

胃肠道肿瘤通过腹腔局部播散和种植可导致腹膜转移癌(peritoneal carcinomatosis,PC),患者常会出现肠梗阻、恶性腹水、疼痛等并发症,为肿瘤终末期,预后较差.胃肠道肿瘤腹膜转移的治疗方法包括全身化疗、腹腔化疗、减瘤手术、减瘤手术联合腹腔热灌注化疗、分子靶向治疗等,这些治疗方法给患者的生存带来不同程度的获益,使腹膜转移癌的预后取得了较大的改善.本文将近年来消化道肿瘤的发病机制及其治疗方法做一回顾总结.     

腹腔热灌注化疗在胃癌腹膜转移治疗中的作用

胃癌发生腹膜转移预后极差,中位生存期小于6个月.全身化疗并没有明显增加这些患者的生存期.腹腔热灌注化疗是目前常用的治疗腹膜转移的方法.全文系统回顾分析了腹腔热灌注化疗在胃癌腹膜转移治疗、进展期胃癌术后辅助治疗以及术前新辅助治疗的疗效.     

细胞减灭术联合腹腔热灌注化疗治疗腹膜癌的围术期规范化护理

目的：探讨如何对细胞减灭术联合腹腔热灌注化疗治疗后的腹膜癌患者进行规范围术期护理。方法对33例腹膜癌患者的围术期护理进行回顾性分析,对护理的具体内容、围术期的不良事件进行总结规范。结果规范的护理减少了围术期不良事件的发生,促进了腹腔化疗管路的改进。结论针对细胞减灭术联合腹腔热灌注化疗治疗腹膜癌的患者进行规范的围术期护理,能够减少围术期不良事件的发生。     

腹腔内热低渗化疗对腹膜种植性癌转移防治效果的实验研究

腹腔内热低渗化疗对腹膜种植性癌转移防治效果的实验研究陈志新，彭德恕，谭建三胃肠道恶性肿瘤患者腹膜种植性癌转移，严重地影响了治疗效果及患者生存率，腹腔内化疗、热等渗液化疗及单纯热低渗液灌注疗法，对杀灭腹腔内游离癌细胞，阻止腹膜癌播散仅具有一定疗效。本实...     

胃癌腹膜转移癌治疗研究进展及我国治疗现状

腹膜转移是胃癌最常见的转移方式之一,是导致治疗失败的主因,严重影响患者预后。全身化疗、腹腔化疗以及姑息性手术的疗效有限,细胞减灭术加腹腔热灌注化疗是可大幅度提高疗效的治疗措施,本文综述了我国胃癌腹膜转移癌的治疗现状和国际研究进展。     

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。     

腹膜癌新发病例的流行病学研究

腹膜癌是指在腹膜上发生和（或）发展的一类恶性肿瘤,包括原发性腹膜癌和继发性腹膜癌。既往认为腹膜癌是一种终末期疾病,无特殊治疗,患者生存期短,预后差。随着对腹膜癌认识的转变,肿瘤学界将其视为一种可治性区域癌转移,开创了以肿瘤细胞减灭术加腹腔热灌注化疗为核心的综合治疗技术体系,并以此建立了专业化腹膜癌诊疗中心,显著延长了患者生存,部分患者甚至能达到临床治愈。然而在中国,目前规范化腹膜癌诊疗中心少,但腹膜癌患者数量庞大,大部分患者得不到规范化治疗,导致生存和预后并不理想。本文旨在根据我国国家癌症中心发布的癌症新发病例统计数据,结合腹膜癌的临床预后资料,按照临床流行病学的研究方法,估算我国所需腹膜癌诊疗中心数,为推广我国腹膜癌规范化诊疗技术体系提供数据支撑,促进腹膜肿瘤学科发展。     

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。     

The use of intraperitoneal chemotherapy for gastric malignancies

Introduction: Gastric cancer is the fourth/fifth most common malignancy worldwide, with only a quarter of patients achieving a 5-year survival rate. It has been estimated that 15–50% or more of patients have peritoneal disease upon surgical exploration. Until the early 1990s, peritoneal metastasis was considered as terminal stage of the disease; in the late 1990s, selected patients with peritoneal metastasis were recategorized as local disease. Over the past two decades, the treatment of peritoneal involvement has transformed, and cytoreductive surgery plus intraperitoneal therapy have drastically altered the natural course of several malignancies.

Areas covered: We performed a review of studies available on PubMed from 1 January 2014 to 31 July 2019 and the analysis of their reference citations. We describe the most current intraperitoneal chemotherapy opportunities in the treatment of gastric cancer: hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC), laparoscopic hyperthermic intraperitoneal chemotherapy (LHIPEC), neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), LHIPEC + NIPS, extensive intraoperative peritoneal lavage (EIPL), early postoperative intraperitoneal chemotherapy (EPIC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Expert opinion: Comprehensive treatment consisting of CRS combined with perioperative intraperitoneal/systemic chemotherapy can, today, be considered an effective strategy to improve the long-term survival of gastric cancer patients with peritoneal metastasis.     

大肠癌术后腹腔低渗温热化疗

目的研究腹腔低渗温热化疗对大肠癌术后腹腔内及肝转移的预防效果.方法收集自1996年7月～1999年12月大肠癌手术病例,随机分为两组A组腹腔低渗温热化疗组.B组常规静脉化疗组.观察腹腔复发率、肝转移率、生存率.结果A组腹腔复发率7.5%(4/53),肝转移率5.7%(3/53),1年、2年生存率分别为96.8%(60/62)、88.7%(55/62).B组腹腔复发率11.8%(6/51),肝转移率15.7%(8/51),1年、2年生存率分别为82.8(48/58)、74.1%(43/58).结论腹腔低渗温热化疗对预防大肠癌术后腹腔内复发、肝转移、提高生存率有显著疗效.     

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。     

Changes induced by surgical and clinical factors in the pharmacology of intraperitoneal mitomycin C in 145 patients with peritoneal carcinomatosis

Background  

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are a combined treatment modality considered for selected patients with peritoneal carcinomatosis from colorectal and appendiceal cancer. Mitomycin C is a drug often used in this clinical setting. The surgical and clinical factors that may influence the pharmacokinetics of hyperthermic intraperitoneal chemotherapy should be further elucidated.     

胃癌术后腹腔热灌注联合全身化疗的临床应用

为研究胃癌术后腹腔热灌注化疗联合全身化疗的治疗效果。对140例胃癌根治术后患者随机分为腹腔热灌注化疗组(n=72)和全身化疗组(n=68)。腹腔热灌注化疗组患者在全身化疗同时应用腹腔热灌注化疗,观察两组术后并发症、不良反应、术后生存率及腹腔复发率。两组在术后并发症及不良反应差异无统计学意义。腹腔热灌注化疗组和全身化疗组术后3、5年生存率分别为86.1%(62/72)、60.2%(41/68)和58.3%(42/72)、29.4%(20/68)(P<0.05)。腹腔热灌注化疗组和全身化疗组术后3、5年腹腔复发率分别为5.6%(4/72)、27.8%(19/68)和20.6%(15/72)、53%(36/68),差异有统计学意义,P<0.05。初步研究结果提示,胃癌术后腹腔热灌注联合全身化疗可有效控制肿瘤的复发和转移,提高胃癌术后患者的生存率。     

Laboratory and clinical basis for hyperthermia as a component of intracavitary chemotherapy

Intraoperative chemotherapy with heat has been identified as a treatment option for patients with cancer spread to peritoneal surfaces. This treatment modality is viewed as a supplement to several other treatments for this group of patients including cytoreductive surgery, systemic chemotherapy, early postoperative intraperitoneal chemotherapy, and long-term bidirectional chemotherapy. The pharmacologic basis for using heat to supplement chemotherapy effects are related to the increased penetration of chemotherapy into tumor with hyperthermia, the delayed clearance of chemotherapy from the peritoneal cavity after direct instillation, and an increased cytotoxicity that has been documented with selected chemotherapy agents. Data to support the use of perioperative hyperthermic intraperitoneal chemotherapy with mucinous appendiceal carcinomatosis comes from a large number of single institution phase II studies. Also, peritoneal and pleural mesothelioma are benefited. In colon cancer carcinomatosis, large phase II multi-institutional trials and a single phase III trial documented an increased median survival of these patients from approximately 1 year to over 2 years. Prophylaxis against peritoneal carcinomatosis in gastric cancer has been demonstrated in phase III trials. In ovarian cancer the rationale for this treatment remains large but its current application is limited. Much work needs to be done to identify a proper clinical perspective on hyperthermia used with chemotherapy in patients with peritoneal surface malignancy.     

Laboratory and clinical basis for hyperthermia as a component of intracavitary chemotherapy.

Intraoperative chemotherapy with heat has been identified as a treatment option for patients with cancer spread to peritoneal surfaces. This treatment modality is viewed as a supplement to several other treatments for this group of patients including cytoreductive surgery, systemic chemotherapy, early postoperative intraperitoneal chemotherapy, and long-term bidirectional chemotherapy. The pharmacologic basis for using heat to supplement chemotherapy effects are related to the increased penetration of chemotherapy into tumor with hyperthermia, the delayed clearance of chemotherapy from the peritoneal cavity after direct instillation, and an increased cytotoxicity that has been documented with selected chemotherapy agents. Data to support the use of perioperative hyperthermic intraperitoneal chemotherapy with mucinous appendiceal carcinomatosis comes from a large number of single institution phase II studies. Also, peritoneal and pleural mesothelioma are benefited. In colon cancer carcinomatosis, large phase II multi-institutional trials and a single phase III trial documented an increased median survival of these patients from approximately 1 year to over 2 years. Prophylaxis against peritoneal carcinomatosis in gastric cancer has been demonstrated in phase III trials. In ovarian cancer the rationale for this treatment remains large but its current application is limited. Much work needs to be done to identify a proper clinical perspective on hyperthermia used with chemotherapy in patients with peritoneal surface malignancy.