Reutovich Mikhail Yu, Krasko Olga V, Sukonko Oleg G
Gastroesophageal Pathology Department, N.N. Alexandrov National Cancer Center, Minsk, Belarus.
United Institute of Informatics Problems, National Academy of Sciences, Minsk, Belarus.
J Gastrointest Oncol. 2021 Apr;12(Suppl 1):S5-S17. doi: 10.21037/jgo-20-129.
Gastric cancer progression resulting in metachronous peritoneal metastasizing is almost always associated with an adverse prognosis. This review discusses various options of preventing metachronous peritoneal metastases in radically operated gastric cancer patients. Also examined are different hyperthermic intraperitoneal chemotherapy (HIPEC) regimens employed in gastric cancer treatment, postoperative morbidity and mortality rates and long-term treatment outcomes. The authors also review their own experience of using HIPEC based on the combination of cisplatin and doxorubicin in doses of 50 mg/m at 42 °C for 1 h to prevent gastric cancer peritoneal dissemination. As a result, progression-free survival rose from 19.6%±5.6% to 47.1%±6.3% (P <0.001) and dissemination-free survival-from 22.7%±6.0% to 51.9%±6.3% (P <0.001). It is noted that the combination of the described HIPEC regimen with systemic chemotherapy helped raise metastases-free 3-year survival rate to up to 91.0%±9.0% (P =0.025) compared with 48.6%±6.4% for patients who underwent only a combined surgery/HIPEC treatment. HIPEC is a promising combined treatment strategy for radically operated gastric cancer patients that can improve patient survival and decrease peritoneal dissemination rate. However, the number of randomized studies on adjuvant HIPEC are still insufficient for a subgroup assessment of efficacy of the given chemotherapy regimens and generation of evidence-based recommendations on the individual use of chemotherapy agents and their combinations, and HIPEC procedural techniques. Further prospective randomized studies are needed to assess the practicability of complementing HIPEC with adjuvant systemic chemotherapies.
胃癌进展导致异时性腹膜转移几乎总是与不良预后相关。本综述讨论了在接受根治性手术的胃癌患者中预防异时性腹膜转移的各种方法。还研究了胃癌治疗中使用的不同热灌注化疗（HIPEC）方案、术后发病率和死亡率以及长期治疗结果。作者还回顾了他们自己使用基于顺铂和阿霉素联合的HIPEC经验，即在42℃下以50mg/m的剂量持续1小时，以预防胃癌腹膜播散。结果，无进展生存期从19.6%±5.6%提高到47.1%±6.3%（P<0.001），无播散生存期从22.7%±6.0%提高到51.9%±6.3%（P<0.001）。值得注意的是，与仅接受联合手术/HIPEC治疗的患者的48.6%±6.4%相比，所述HIPEC方案与全身化疗相结合有助于将无转移3年生存率提高到91.0%±9.0%（P =0.025）。HIPEC是一种有前景的联合治疗策略，适用于接受根治性手术的胃癌患者，可提高患者生存率并降低腹膜播散率。然而，关于辅助性HIPEC的随机研究数量仍然不足，无法对给定化疗方案的疗效进行亚组评估，也无法就化疗药物及其组合的个体化使用以及HIPEC程序技术生成循证推荐。需要进一步的前瞻性随机研究来评估辅助性全身化疗补充HIPEC的实用性。
