Department of Abdominal, Vascular and Transplant Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109 Cologne, Germany.
Expert Rev Anticancer Ther. 2011 Oct;11(10):1505-8. doi: 10.1586/era.11.147.
Peritoneal carcinomatosis (PC) is the most common pattern of metastasis and recurrence in patients with gastric cancer and is associated with poor clinical outcome and survival. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) was recently established as a new treatment option for PC of gastrointestinal cancer. However, the role of cytoreductive surgery in gastric cancer and the intrinsic role of HIPEC remains unclear. The evaluated article presented a single center Phase III study, randomizing 68 patients with PC from gastric cancer to surgical cytoreduction only (CRS; n = 34) versus cytoreduction plus HIPEC with cisplatin and mitomycin (CRS+HIPEC; n = 34). Median overall was 6.5 months in the CRS group and 11.0 months in the CRS+HIPEC group (p = 0.046). Serious adverse events were acceptable in both groups. Multivariate analysis found CRS+HIPEC, synchronous PC, complete cytoreduction, systemic chemotherapy >6 cycles and no incidence of severe adverse events independent predictive factors for survival. This was the first study to show the positive effects of HIPEC in addition to CRS in PC independently of the tumor entity. In patients with gastric cancer, multimodal treatment concepts combining surgical cytoreduction and HIPEC may provide a new option in carefully selected patients.
腹膜癌病（PC）是胃癌患者最常见的转移和复发模式，与不良临床结局和生存相关。细胞减灭术和腹腔热灌注化疗（HIPEC）最近被确立为胃肠道癌症 PC 的一种新的治疗选择。然而，细胞减灭术在胃癌中的作用和 HIPEC 的内在作用仍不清楚。评估的文章提出了一项单中心 III 期研究，将 68 名来自胃癌的 PC 患者随机分为仅行细胞减灭术（CRS；n = 34）或细胞减灭术加顺铂和丝裂霉素 HIPEC（CRS+HIPEC；n = 34）。CRS 组的中位总生存期为 6.5 个月，CRS+HIPEC 组为 11.0 个月（p = 0.046）。两组的严重不良事件均可接受。多变量分析发现，CRS+HIPEC、同步 PC、完全细胞减灭术、全身化疗 >6 个周期和无严重不良事件是独立的生存预测因素。这是第一项表明 HIPEC 除了 CRS 以外，对 PC 具有独立作用的研究，而与肿瘤实体无关。对于胃癌患者，结合手术减瘤和 HIPEC 的多模态治疗概念可能为精心挑选的患者提供新的选择。
