Losa F, Barrios P, Salazar R, Torres-Melero J, Benavides M, Massuti T, Ramos I, Aranda E
Consorci Sanitari Integral (H. Sant Joan Despí. Moisès Broggi. Barcelona), Barcelona, Spain,
Clin Transl Oncol. 2014 Feb;16(2):128-40. doi: 10.1007/s12094-013-1053-x. Epub 2013 Jun 6.
Peritoneal carcinomatosis (PC) is a common form of tumour metastasis stemming from gastrointestinal and colorectal cancers. For a long time, PC has been considered a terminal clinical condition treated only with palliative systemic chemotherapy and associated with very limited results. During the last decade, the treatment of advanced colorectal disease has greatly improved with the emergence of new chemotherapy drugs and biological agents. However, the median survival rates still do not surpass 24 months, even though most of these studies correspond to groups of patients with metastatic disease to the liver and/or lung. The approach and development of cytoreductive radical surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) are based on performing radical surgery of the entire visible tumour within the abdomen/peritoneum, followed immediately by HIPEC, which acts upon microscopic tumour that remains present after surgery and which is responsible for the persistence or relapse of peritoneal disease. Peritonectomy procedures are demanding surgical techniques that permit elimination of the tumour present in the peritoneal lining and any other organs and/or structures that are infiltrated. The synergistic effect of hyperthermia and chemotherapy has been well documented. Hyperthermia increases the cytotoxicity of some cytostatic agents and increases the penetration of certain drugs into the neoplastic cells. The prognosis for patients with PC who undergo combined treatment correlates with the volume of PC (tumour burden) measured as the Peritoneal Cancer Index (PCI) and the ability to perform a CRS, to completely eliminate the gross tumour. At least one phase III study and an important number of phase II studies have shown that CRS + HIPEC provides important survival benefits for patients with PC of colorectal origin. The combination of CRS + HIPEC is indicated for patients with good general health, a low PCI, absence of extra-abdominal metastasis and who can, technically, undergo CRS. The early identification of this group of patients, rapid referral to centres specialised in CRS + HIPEC, together with the correct application of this treatment, are key in achieving the best results.
腹膜癌病（PC）是胃肠道和结直肠癌常见的肿瘤转移形式。长期以来，PC一直被视为一种终末期临床病症，仅采用姑息性全身化疗进行治疗，且疗效非常有限。在过去十年中，随着新型化疗药物和生物制剂的出现，晚期结直肠癌疾病的治疗有了很大改善。然而，即使这些研究大多针对肝和/或肺转移疾病患者群体，其平均生存率仍未超过24个月。细胞减灭性根治性手术（CRS）+腹腔内热灌注化疗（HIPEC）的方法和发展基于对腹部/腹膜内所有可见肿瘤进行根治性手术，随后立即进行HIPEC，HIPEC作用于手术后残留的微小肿瘤，这些微小肿瘤是腹膜疾病持续存在或复发的原因。腹膜切除术是要求较高的手术技术，可清除腹膜内衬以及任何其他受浸润的器官和/或结构中存在的肿瘤。热疗和化疗的协同作用已有充分记录。热疗可增加某些细胞抑制剂的细胞毒性，并增加某些药物进入肿瘤细胞的渗透率。接受联合治疗的PC患者的预后与以腹膜癌指数（PCI）衡量的PC体积（肿瘤负荷）以及进行CRS以完全清除肉眼可见肿瘤的能力相关。至少一项III期研究和大量II期研究表明，CRS + HIPEC为结直肠源性PC患者提供了重要的生存益处。CRS + HIPEC联合治疗适用于一般健康状况良好、PCI低、无腹外转移且在技术上能够接受CRS的患者。早期识别这组患者、迅速转诊至专门从事CRS + HIPEC的中心以及正确应用这种治疗方法，是取得最佳治疗效果的关键。
