Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-8471, Japan.
Support Care Cancer. 2020 Dec;28(12):5861-5869. doi: 10.1007/s00520-020-05401-4. Epub 2020 Apr 6.
Gastrointestinal cancer is frequently associated with malignant ascites, resulting in poor prognosis. While cell-free and concentrated ascites reinfusion therapy (CART) improves ascites-related symptoms, its clinical impact in combination with systemic chemotherapy is unclear. The purpose of this study was to evaluate the safety and efficacy of CART in gastrointestinal cancer patients with massive ascites treated with chemotherapy.
We retrospectively reviewed the medical records of gastrointestinal cancer patients with massive ascites who received CART and chemotherapy at our hospital between July 2015 and September 2017.
A total of 30 patients received CART and chemotherapy: gastric cancer (n = 21) and colorectal cancer (n = 9). The initial CART improved performance status in 20% of the patients, and the mean serum albumin and creatinine was significantly improved. Median time to treatment failure and overall survival of chemotherapy following CART were 2.1 and 3.5 months in gastric cancer patients and 5.8 and 5.8 months in colorectal cancer patients, respectively. The frequency of paracentesis was decreased after introduction of CART followed by chemotherapy in 83% of gastric cancer and in all colorectal cancer patients who had received paracentesis before the initial CART. There were no grade 3/4 adverse events during the CART procedure. Grade 3/4 hematotoxic and non-hematotoxic adverse events of chemotherapy following CART were 30% and less than 10%, respectively.
The combination of CART followed by chemotherapy is safe and could be a treatment option for gastrointestinal cancer patients with massive ascites.
胃肠道癌症常伴有恶性腹水，导致预后不良。虽然无细胞和浓缩腹水再输注治疗（CART）可改善与腹水相关的症状，但与全身化疗联合应用的临床效果尚不清楚。本研究旨在评估 CART 联合化疗治疗大量腹水胃肠道癌症患者的安全性和疗效。
我们回顾性分析了 2015 年 7 月至 2017 年 9 月在我院接受 CART 和化疗的大量腹水胃肠道癌症患者的病历资料。
共 30 例患者接受了 CART 和化疗：胃癌（n=21）和结直肠癌（n=9）。初始 CART 使 20%的患者的体能状态得到改善，血清白蛋白和肌酐的均值显著提高。CART 后化疗的中位治疗失败时间和总生存期分别为 2.1 个月和 3.5 个月（胃癌患者）和 5.8 个月和 5.8 个月（结直肠癌患者）。在接受 CART 联合化疗后，83%的胃癌患者和所有接受过初始 CART 前腹腔穿刺术的结直肠癌患者的腹腔穿刺术频率均减少。CART 过程中无 3/4 级不良事件。CART 后化疗的 3/4 级血液毒性和非血液毒性不良事件发生率分别为 30%和低于 10%。
CART 联合化疗是安全的，可为大量腹水的胃肠道癌症患者提供一种治疗选择。
