Cavaliere F, Di Filippo F, Botti C, Cosimelli M, Giannarelli D, Aloe L, Arcuri E, Aromatario C, Consolo S, Callopoli A, Laurenzi L, Tedesco M, Di Angelo P, Giunta S, Cavaliere R
First Department of Surgical Oncology, Regina Elena National Cancer Institute, Rome, Italy.
Eur J Surg Oncol. 2000 Aug;26(5):486-91. doi: 10.1053/ejso.1999.0927.
Some low-grade malignant tumours arising in the abdomen tend to remain loco-regionally confined to peritoneal surfaces, without systemic dissemination. In these cases complete surgical tumour cytoreduction followed by intra- or post-operative regional chemotherapy has curative potential. The aim of this study was to evaluate the outcome for patients treated in this way.
Peritonectomy was performed, involving the complete removal of all the visceral and parietal peritoneum involved by disease. After peritonectomy, hyperthermic antiblastic perfusion was carried out throughout the abdominopelvic cavity for 90 min, at a temperature of 41.5-42.5 degrees C, with mitomycin C (3.3 mg/m2/l) and cisplatin (25 mg/m2/l) (for appendicular or colorectal primaries), or cisplatin alone (for ovarian primaries). Alternatively, the immediate post-operative regional chemotherapy was performed with 5-fluorouracil (13.5 mg/kg) and Lederfolin (125 mg/m2) (for colonic or appendicular tumours) or cisplatin (25 mg/m2) (for ovarian tumours), each day for 5 days.
Thirty-five patients affected by extensive peritoneal carcinomatosis were submitted to peritonectomy, with no residual macroscopic disease in all cases except three. Twenty-six patients were able to undergo the combined treatment involving loco-regional chemotherapy. Complications were observed in 54% of the patients and led to death in four of them. At a mean follow-up of 17 months overall 2-year survival was 55.2%, with a median survival of 26 months.
After a learning curve of 18 months the feasibility of the integrated treatment increased to more than 90%, while mortality decreased dramatically. The curative potential of the combined therapeutic approach seems high in selected patients with peritoneal carcinomatosis not responding to systemic chemotherapy. Careful selection of patients can minimize the surgical risk, but the treatment should currently be reserved for clinical trials.
一些起源于腹部的低度恶性肿瘤倾向于局限在局部区域，局限于腹膜表面，无全身播散。在这些病例中，完整的手术肿瘤细胞减灭术联合术中和术后区域化疗具有治愈潜力。本研究的目的是评估采用这种方式治疗的患者的预后。
实施腹膜切除术，包括完整切除所有受累的脏层和壁层腹膜。腹膜切除术后，在腹腔和盆腔进行90分钟的热灌注化疗，温度为41.5 - 42.5摄氏度，使用丝裂霉素C（3.3毫克/平方米/升）和顺铂（25毫克/平方米/升）（用于阑尾或结直肠原发性肿瘤），或单独使用顺铂（用于卵巢原发性肿瘤）。或者，术后立即进行区域化疗，使用5 - 氟尿嘧啶（13.5毫克/千克）和亚叶酸钙（125毫克/平方米）（用于结肠或阑尾肿瘤）或顺铂（25毫克/平方米）（用于卵巢肿瘤），每天一次，共5天。
35例广泛腹膜癌转移患者接受了腹膜切除术，除3例外在所有病例中均无肉眼可见的残留病灶。26例患者能够接受包括局部区域化疗的联合治疗。54%的患者观察到并发症，其中4例死亡。平均随访17个月时，总体2年生存率为55.2%，中位生存期为26个月。
经过18个月的学习曲线后，综合治疗的可行性提高到90%以上，同时死亡率显著下降。联合治疗方法在某些对全身化疗无反应的腹膜癌转移患者中似乎具有较高的治愈潜力。仔细选择患者可以将手术风险降至最低，但目前该治疗应保留用于临床试验。
