Department of Surgery, CRLC Val d'Aurelle, Montpellier, France.
Ann Surg. 2011 Aug;254(2):294-301. doi: 10.1097/SLA.0b013e3182263933.
To assess the perioperative and long-term results of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) using oxaliplatin+irinotecan (ox-irino) versus oxaliplatin alone (ox-alone).
Treatment of peritoneal carcinomatosis (PC) of colorectal origin with CRS+HIPEC using mitomycin-C or oxaliplatin monotherapy has shown encouraging survival results. This bi-centric study evaluates an intensified intraperitoneal combination of ox-irino and compares it with ox-alone.
All consecutive patients with PC undergoing CRS+HIPEC using either ox-alone or ox-irino between 1998 and 2007 were evaluated.
One hundred forty-six patients underwent CRS+HIPEC for PC, 103 received ox-irino and 43 received ox-alone. The median peritoneal carcinomatosis index (PCI) was 11 in both groups. 90.4% had complete cytoreduction. Overall mortality rate was 4.1%. The overall morbidity rate was 47.2% and was significantly lower with ox-alone (34.9% vs. 52.4%, P = 0.05). After a median follow-up of 48.5 months, the median overall survival (OS) was 41 months (95% CI, 32-60) and median relapse-free survival (RFS) was 15.7 months (95% CI, 12-18). The median RFS of ox-alone (16.8 months; 95% CI, 11-25) was not significantly different from ox-irino (15.7 months; 95% CI, 11-18; P = 0.93). There was no significant difference between median OS of ox-alone (40.83 months; 95% CI, 29-61) and ox-irino (47 months; 95% CI, 32-61; P = 0.94). At 5 years, OS and RFS rates were 41.8% and 13.8% in ox-alone and 42.4% and 14.2% in ox-irino, respectively. Prognostic factors confirmed on multivariate analysis were lymph node metastasis and PCI.
Our study showed no advantage of intensification of HIPEC by adding irinotecan, contrary to the results obtained with IV combination. Ox-alone HIPEC should continue as one of the standard HIPEC regimens for PC.
评估使用奥沙利铂+伊立替康（ox-irino）与奥沙利铂单药（ox-alone）进行细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的围手术期和长期结果。
用丝裂霉素 C 或奥沙利铂单药治疗结直肠来源的腹膜癌（PC）的 CRS+HIPEC 显示出令人鼓舞的生存结果。这项双中心研究评估了 ox-irino 的强化腹腔内联合用药，并将其与 ox-alone 进行了比较。
1998 年至 2007 年间，所有接受 ox-alone 或 ox-irino 治疗的 PC 行 CRS+HIPEC 的连续患者均接受评估。
146 例患者行 PC 的 CRS+HIPEC，其中 103 例接受 ox-irino，43 例接受 ox-alone。两组的中位腹膜癌指数（PCI）均为 11。90.4%达到完全肿瘤减灭。总死亡率为 4.1%。总发病率为 47.2%，ox-alone 组明显较低（34.9%比 52.4%，P=0.05）。中位随访 48.5 个月后，中位总生存期（OS）为 41 个月（95%CI，32-60），中位无复发生存期（RFS）为 15.7 个月（95%CI，12-18）。ox-alone 的中位 RFS（16.8 个月；95%CI，11-25）与 ox-irino（15.7 个月；95%CI，11-18；P=0.93）无显著差异。ox-alone 的中位 OS（40.83 个月；95%CI，29-61）与 ox-irino（47 个月；95%CI，32-61；P=0.94）无显著差异。5 年时，ox-alone 的 OS 和 RFS 率分别为 41.8%和 13.8%，ox-irino 分别为 42.4%和 14.2%。多因素分析确认的预后因素为淋巴结转移和 PCI。
我们的研究表明，与 IV 联合用药的结果相反，通过添加伊立替康强化 HIPEC 并没有优势。ox-alone HIPEC 应继续作为 PC 的标准 HIPEC 方案之一。
