Lim C, Tordjmann D, Gornet J-M, Nemeth J, Valleur P, Pocard M
Hôpital Lariboisière, Département médicochirurgical de pathologie digestive, Université Paris-Diderot-Paris-VII, France.
Bull Cancer. 2010 Sep;97(9):1053-60. doi: 10.1684/bdc.2010.1165.
Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is now the reference technique for limited peritoneal carcinomatosis (PC). Operative mortality is actually at 3 or 4%, and decrease as morbidity. Together, they did not limit acceptation of HIPEC. However, one of the major limitation of this aggressive treatment is that patient can be afraid to impair overall quality of life (QoL). The aim of this article was to assess QoL in patients at least 12 months after HIPEC using Oxaliplatin.
Patients completed a questionnaire before and after surgery at 1, 3, 6 and 12 months. QoL was assessed with the EORTC QLQ-C30 questionnaire. RESULTATS: Between September 2006 and October 2008, 32 of 35 patients who had undergone HIPEC were interviewed. PC originated in primary lesions of the colon/rectum (N = 17), ovary (N = 3), stomach (N = 3), appendix (N = 2), mesothelium (N = 2), pseudomyxoma peritonei (N = 3) and primary carcinoma of peritoneum (N = 2). The percentage of patients completing the questionnaire at each time point was: baseline = 87% (N = 28); 1 and 3 months = 46% (N = 15); 6 months = 62% (N = 20); and 12 months = 59% (N = 19). Morbidity and mortality were respectively 35 and 5%. Median hospital stay was 19 days. QoL score had decreased considerably in 60% of patients in the early postoperative assessment period after HIPEC (1 month), as compared with baseline score. Forty five per cent had reported significant pain and limitations on physical functioning. QoL score had returned to baseline at 3 months in 53,3% of patients: 20% reported lack of energy and fatigue. Fifty-five and 73% of patients had recovered their overall QoL at 6 and 12 months, respectively. Also, psychosocial problems, diarrhea and constipation, and peripheral neuropathy of oxaliplatin were reported in 20% of survivors over the course of the first year after HIPEC.
Short-term QoL with physical and functional well-being are impaired in the first few months after surgery plus HIPEC using oxaliplatin. Long-term QoL returns to baseline at 3 months; however 20% of patients still report psychosocial problems, gastrointestinal symptoms and oxaliplatin-induced neuropathy. It is useful and important for patients to see this HIPEC QoL data at the time of consultation before treatment.
细胞减灭术联合热灌注化疗（HIPEC）目前是局限性腹膜癌转移（PC）的标准治疗技术。手术死亡率目前为3%或4%，且随着发病率的降低而下降。总体而言，它们并未限制HIPEC的应用。然而，这种积极治疗的主要局限性之一在于患者可能担心会损害总体生活质量（QoL）。本文旨在评估使用奥沙利铂进行HIPEC治疗至少12个月后的患者生活质量。
患者在手术前以及术后1个月、3个月、6个月和12个月完成一份问卷。使用欧洲癌症研究与治疗组织（EORTC）QLQ-C30问卷评估生活质量。
在2006年9月至2008年10月期间，对35例行HIPEC治疗的患者中的32例进行了访谈。PC起源于结肠/直肠原发性病变（N = 17）、卵巢（N = 3）、胃（N = 3）、阑尾（N = 2）、间皮（N = 2）、腹膜假黏液瘤（N = 3）和腹膜原发性癌（N = 2）。在每个时间点完成问卷的患者百分比分别为：基线时 = 87%（N = 28）；1个月和3个月时 = 46%（N = 15）；6个月时 = 62%（N = 20）；12个月时 = 59%（N = 19）。发病率和死亡率分别为35%和5%。中位住院时间为19天。与基线评分相比，在HIPEC术后早期评估期（1个月），60%的患者生活质量评分显著下降。45%的患者报告有明显疼痛和身体功能受限。53.3%的患者在3个月时生活质量评分恢复至基线：20%的患者报告缺乏精力和疲劳。分别有55%和73%的患者在6个月和12个月时恢复了总体生活质量。此外，在HIPEC术后的第一年中，20%的幸存者报告有心理社会问题、腹泻和便秘以及奥沙利铂引起的周围神经病变。
使用奥沙利铂进行手术加HIPEC治疗后的最初几个月，患者的短期生活质量以及身体和功能健康受到损害。长期生活质量在3个月时恢复至基线；然而，20%的患者仍报告有心理社会问题、胃肠道症状和奥沙利铂引起的神经病变。在治疗前咨询时让患者了解这些HIPEC生活质量数据是有用且重要的。
