Wang Daguang, Xing Yanpeng, Guo YuChen, Zhang Yang, Chen Yujia, Suo Jian
Department of Gastrointestinal Suegery, First Hospital of Jilin University, Changchun 130021, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 May;19(5):540-4.
The aim of this study is to discuss the curative effect of introperitoneal hyperthermic perfusion chemotherapy(IHPC) combined with systemic neoadjuvant chemotherapy on the gastric cancer patients with peritoneal carcinomatosis.
Sixty-four patients with gastric cancer and peritoneal carcinomatosis who were hospitalized in the Department of Gastrointestinal Surgery of First Hospital of Jilin University from December 2006 to December 2013. After peritoneal carcinomatosis was confirmed during laparoscopic exploration, FOLFOX6 (oxaliplatin and calcium folinate and 5-Fu) was performed for systemic chemotherapy. One course was 14 days and a complete treatment includes four courses. At the same time, patients underwent peritoneal catheter insertion and received IHPC(5-Fu 1 500 mg/m(2) and Cisplatin 35 mg/m(2) were added into 0.9% NaCl solution 2 000 ml, the infusion velocity was 35-45 ml/min, infusion time was 45-60 minutes, the temperature was controlled to 41°C). A comprehensive evaluation was taken after the fourth course of treatment before operation. Further surgical therapy was performed according to the assessment result.
Sixty-four patients received IHPC combined with systemic chemotherapy. Thirty-two patients(50.0%) had partial response, 18(28.1%) stable disease, and 14(21.9%) progressive disease after chemotherapy. No severe complications or death occurred during the neoadjuvant chemotherapy. Thirty-two patients(50.0%) received radical resection, 10(15.6%) palliative operation, and another 22 patients(37.4%) didn't comply with inclusion criteria of operation. Patients receiving operation had a median survival time of 678 days, which was significantly longer than patients without operation, with a median survival time of 251(χ(2)=23.34, P=0.02).
IHPC combined with systemic chemotherapy is an effective therapeutic method for gastric cancer patients with peritoneal carcinomatosis in terms of reducing preoperative tumor load and achieving radical resection.
本研究旨在探讨腹腔热灌注化疗（IHPC）联合全身新辅助化疗对伴有腹膜转移癌的胃癌患者的疗效。
选取2006年12月至2013年12月在吉林大学第一医院胃肠外科住院的64例伴有腹膜转移癌的胃癌患者。在腹腔镜探查确诊腹膜转移癌后，采用FOLFOX6（奥沙利铂、亚叶酸钙和5-氟尿嘧啶）进行全身化疗。1个疗程为14天，完整治疗包括4个疗程。同时，患者接受腹腔置管并进行腹腔热灌注化疗（将5-氟尿嘧啶1500mg/m²和顺铂35mg/m²加入2000ml 0.9%氯化钠溶液中，输注速度为35-45ml/min，输注时间为45-60分钟，温度控制在41°C）。在术前第4个疗程治疗后进行综合评估。根据评估结果进一步行手术治疗。
64例患者接受了腹腔热灌注化疗联合全身化疗。化疗后32例患者（50.0%）部分缓解，18例（28.1%）病情稳定，14例（21.9%）病情进展。新辅助化疗期间未发生严重并发症或死亡。32例患者（50.0%）接受了根治性切除，10例（15.6%）接受了姑息性手术，另外22例患者（37.4%）不符合手术纳入标准。接受手术的患者中位生存时间为678天，明显长于未接受手术的患者，未接受手术患者的中位生存时间为251天（χ²=23.34，P=0.02）。
腹腔热灌注化疗联合全身化疗在降低术前肿瘤负荷及实现根治性切除方面是治疗伴有腹膜转移癌胃癌患者的有效治疗方法。
