Kerbage Y, Canlorbe G, Estevez J P, Grabarz A, Mordon S, Uzan C, Collinet P, Azaïs H
Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France.
Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
Gynecol Obstet Fertil Senol. 2018 May;46(5):497-502. doi: 10.1016/j.gofs.2018.03.011. Epub 2018 Apr 11.
Understanding the biology and progression mechanisms of peritoneal metastases in ovarian epithelial cancers (EOC) is important because peritoneal carcinomatosis is present or will occur during surveillance of a majority of patients. Despite the clinical remission achieved after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, 60% of patients will develop peritoneal recurrence. This suggests that microscopic lesions, which are not eradicated by surgery may be present and may participate in the mechanisms leading to peritoneal recurrence. This paper discusses current available data on microscopic peritoneal metastases, their diagnosis and their treatment. We reviewed all publications dealing with microscopic peritoneal metastases of EOC between 1980 and 2017. The most recent and most relevant publications dealing with the treatment modalities of these metastases were selected. Peritoneal and epiploic microscopic localizations would occur in 1.2 to 15.1% of cases at early-stage and are not treated during conventional surgery. They could represent a potential therapeutic target. Local treatments (intraperitoneal chemotherapy, photodynamic therapy, fluorescence-guided surgery) seem to be necessary in addition to surgery and chemotherapy and may help reduce the risk of peritoneal recurrence. The place of these treatments in the management of EOC remains to be defined by subsequent researches.
了解卵巢上皮癌（EOC）腹膜转移的生物学特性和进展机制非常重要，因为大多数患者在监测期间会出现或将会发生腹膜癌。尽管在进行了完全宏观减瘤手术和铂类化疗后实现了临床缓解，但仍有60%的患者会出现腹膜复发。这表明手术未能根除的微小病灶可能存在，并可能参与导致腹膜复发的机制。本文讨论了有关微小腹膜转移灶的现有数据、其诊断和治疗。我们回顾了1980年至2017年间所有涉及EOC微小腹膜转移的出版物。选择了有关这些转移灶治疗方式的最新且最相关的出版物。早期病例中，腹膜和网膜微小转移灶的发生率为1.2%至15.1%，在常规手术中未得到治疗。它们可能是一个潜在的治疗靶点。除手术和化疗外，局部治疗（腹腔内化疗、光动力疗法、荧光引导手术）似乎是必要的，可能有助于降低腹膜复发的风险。这些治疗在EOC管理中的地位仍有待后续研究确定。
