Gómez Portilla A, Cendoya I, López de Tejada I, Olabarría I, Martínez de Lecea C, Magrach L, Gil A, Echevarría J, Valdovinos M, Larrabide I
Peritoneal Carcinomatosis Programme, Policlínica San José, Vitoria, Spain.
Rev Esp Enferm Dig. 2005 Oct;97(10):716-37. doi: 10.4321/s1130-01082005001000005.
Colorectal cancer is the most frequent tumor of the digestive tract. The high incidence of abdominal dissemination; the poor prognosis of these patients, with median survival consistently ranging from 5 to 9 months in all studies of peritoneal carcinomatosis from colorectal cancer; the failure of adjuvant systemic chemotherapy treatment with a maximal survival of 18 months despite the development of new cytostatic drugs, and new combinations of use, make it crucial to search for and develop new treatment strategies. We review the principles of Sugarbaker s treatment protocol, which involves the combination of maximum cytoreductive radical oncological surgery for the treatment of all macroscopically disseminated disease with maximum perioperative intraperitoneal intensification chemotherapy to treat residual microscopic disease. We present the results of several scientific papers, all of them phase II studies with more than 10 patients treated, published in the medical literature by the main groups working in this line of treatment, together with the only phase III study reported and published so far, and finally the results of a recently reported retrospective international multicenter study. With this new alternative therapeutic approach, overall mean survival is 40% at 36 months, and 20% at 5 years. Based on these results, this new therapeutic approach is proposed as the treatment of choice for these unfortunate patients.
结直肠癌是消化道最常见的肿瘤。腹部播散发生率高；这些患者预后较差，在所有结直肠癌腹膜转移的研究中，中位生存期一直为5至9个月；尽管有新的细胞毒性药物及新的联合用药方式，但辅助全身化疗的效果不佳，最大生存期仅18个月，因此寻找和开发新的治疗策略至关重要。我们回顾了Sugarbaker治疗方案的原则，该方案包括采用最大程度的细胞减灭性根治性肿瘤手术治疗所有肉眼可见的播散性疾病，并结合最大程度的围手术期腹腔内强化化疗治疗残留的微小疾病。我们展示了几篇科学论文的结果，所有这些都是II期研究，治疗患者超过10例，由从事该治疗领域的主要研究团队发表在医学文献中，同时还展示了迄今为止报道和发表的唯一一项III期研究结果，最后是最近报道的一项回顾性国际多中心研究的结果。采用这种新的替代治疗方法，36个月时总体平均生存率为40%，5年时为20%。基于这些结果，建议将这种新的治疗方法作为这些不幸患者的首选治疗方案。
