Department of Gastrointestinal Surgery, Jichi Medical University, Tochigi, Japan.
Department of Chemotherapy, Jichi Medical University, Tochigi, Japan.
Ann Surg Oncol. 2021 Jul;28(7):3863-3870. doi: 10.1245/s10434-020-09388-4. Epub 2020 Dec 3.
Intraperitoneal (IP) administration of paclitaxel (PTX) has a great pharmacokinetic advantage to control peritoneal lesions and can be combined with various systemic chemotherapies. In this study, we evaluate the efficacy and tolerability of a combination of IP-PTX and systemic S-1/oxaliplatin (SOX) for induction chemotherapy for patients with peritoneal metastases (PM) from gastric cancer (GC).
Patients with GC who were diagnosed as macroscopic PM (P1) or positive peritoneal cytology (CY1) by staging laparoscopy between 2016 and 2019 were enrolled. PTX was IP administered at 40 mg/m on days 1 and 8. Oxaliplatin was IV administered at 100 mg/m on day 1, and S-1 was administered at 80 mg/m/day for 14 consecutive days, repeated every 21 days. Survival time and toxicities were retrospectively explored.
Forty-four patients received SOX + IP-PTX with a median (range) of 16 (1-48) courses, although oxaliplatin was suspended due to the hematotoxicity or intolerable peripheral neuropathy in many patients. The 1-year overall survival (OS) rate was 79.5% (95% CI 64.4-88.8%) with median survival time of 25.8 months. Gastrectomy was performed in 20 (45%) patients who showed macroscopic shrinkage of PM with a 1-year OS rate of 100% (95% CI 69.5-100%). Grade 2 and 3 histological responses was achieved in four (20%) and one (5%) patients. Grade 3/4 toxicities included neutropenia (11%), leukopenia (39%), and anemia (14%). There were no treatment-related deaths.
Combination chemotherapy using SOX + IP-PTX regimen is highly effective and recommended as induction chemotherapy for patients with PM from GC.
腹腔内（IP）给予紫杉醇（PTX）具有控制腹膜病变的巨大药代动力学优势，并可与各种全身化疗联合使用。在这项研究中，我们评估了 IP-PTX 联合全身 S-1/奥沙利铂（SOX）用于治疗胃癌（GC）腹膜转移（PM）患者诱导化疗的疗效和耐受性。
纳入 2016 年至 2019 年接受分期腹腔镜检查诊断为宏观 PM（P1）或阳性腹膜细胞学（CY1）的 GC 患者。PTX 于第 1 天和第 8 天给予 40mg/m2 IP 给药。奥沙利铂于第 1 天给予 100mg/m2 IV 给药，S-1 于第 1 天给予 80mg/m2/d 连续 14 天，每 21 天重复一次。回顾性探索生存时间和毒性。
44 例患者接受了 SOX+IP-PTX 治疗，中位数（范围）为 16（1-48）个疗程，尽管许多患者因血液毒性或无法耐受的周围神经病变而暂停使用奥沙利铂。1 年总生存率（OS）为 79.5%（95%CI 64.4-88.8%），中位生存时间为 25.8 个月。20 例（45%）患者行胃切除术，PM 宏观缩小，1 年 OS 率为 100%（95%CI 69.5-100%）。4 例（20%）和 1 例（5%）患者达到 2 级和 3 级组织学反应。3/4 级毒性包括中性粒细胞减少症（11%）、白细胞减少症（39%）和贫血（14%）。无治疗相关死亡。
SOX+IP-PTX 方案联合化疗对 GC 腹膜转移患者具有高度疗效，推荐作为诱导化疗。
