Kono Koji, Yong Wei-Peng, Okayama Hirokazu, Shabbir Asim, Momma Tomoyuki, Ohki Shinji, Takenoshita Seiichi, So Jimmy
Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Department of Surgery, National University of Singapore, Singapore, Singapore.
Gastric Cancer. 2017 Mar;20(Suppl 1):122-127. doi: 10.1007/s10120-016-0660-y. Epub 2016 Oct 20.
Among advanced gastric cancer cases, peritoneal dissemination is a life-threatening mode of metastasis, and any strategy to control peritoneal metastasis will significantly improve treatment outcomes. Since intraperitoneal administration of anticancer drugs can induce an extremely high concentration of drugs in the peritoneal cavity, intraperitoneal chemotherapy would appear to be a reasonable and promising strategy to control the peritoneal dissemination. However, it has been reported in the past that intraperitoneal administration of mitomycin C or cisplatin resulted in no significant clinical effects against peritoneal metastasis of gastric cancer. In contrast, intraperitoneal paclitaxel is expected to remain inside the peritoneal cavity due to its large molecular weight and fat solubility, leading to a high concentration of the drug in the peritoneal cavity. In fact, promising results in several phase II clinical trials using intraperitoneal paclitaxel have been reported, including a median survival time of 16.2-24.6 months and a 1-year overall survival rate of 69-78 %. Thereafter, a phase III randomized control study (PHOENIX-GC trial) with intraperitoneal paclitaxel plus systemic S-1 and intravenous paclitaxel in comparison to systemic S-1 plus cisplatin was conducted in Japan. Moreover, a phase II clinical trial of combination chemotherapy of intraperitoneal paclitaxel with systemic capecitabine plus oxaliplatin is currently ongoing in Singapore. In this review, based on clinical experience from Singapore and Japan, the clinical significance of intraperitoneal chemotherapy for gastric cancer with peritoneal disease is discussed.
在进展期胃癌病例中，腹膜播散是一种危及生命的转移方式，任何控制腹膜转移的策略都将显著改善治疗效果。由于腹腔内给药抗癌药物可在腹腔内诱导极高的药物浓度，腹腔内化疗似乎是控制腹膜播散的合理且有前景的策略。然而，过去有报道称，腹腔内注射丝裂霉素C或顺铂对胃癌腹膜转移没有显著临床效果。相比之下，腹腔内注射紫杉醇因其分子量较大和脂溶性，有望留在腹腔内，从而使腹腔内药物浓度较高。事实上，已有报道称在几项使用腹腔内紫杉醇的II期临床试验中取得了令人鼓舞的结果，包括中位生存时间为16.2 - 24.6个月，1年总生存率为69 - 78%。此后，日本进行了一项III期随机对照研究（PHOENIX - GC试验），比较腹腔内紫杉醇加全身S - 1与静脉注射紫杉醇联合全身S - 1加顺铂的疗效。此外，新加坡目前正在进行一项腹腔内紫杉醇与全身卡培他滨加奥沙利铂联合化疗的II期临床试验。在本综述中，基于新加坡和日本的临床经验，讨论了腹腔内化疗对伴有腹膜病变的胃癌的临床意义。
