Ceelen Wim, Demuytere Jesse, de Hingh Ignace
Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium.
Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium.
Cancers (Basel). 2021 Jun 22;13(13):3114. doi: 10.3390/cancers13133114.
With increasing awareness amongst physicians and improved radiological imaging techniques, the peritoneal cavity is increasingly recognized as an important metastatic site in various malignancies. Prognosis of these patients is usually poor as traditional treatment including surgical resection or systemic treatment is relatively ineffective. Intraperitoneal delivery of chemotherapeutic agents is thought to be an attractive alternative as this results in high tumor tissue concentrations with limited systemic exposure. The addition of hyperthermia aims to potentiate the anti-tumor effects of chemotherapy, resulting in the concept of heated intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal metastases as it was developed about 3 decades ago. With increasing experience, HIPEC has become a safe and accepted treatment offered in many centers around the world. However, standardization of the technique has been poor and results from clinical trials have been equivocal. As a result, the true value of HIPEC in the treatment of peritoneal metastases remains a matter of debate. The current review aims to provide a critical overview of the theoretical concept and preclinical and clinical study results, to outline areas of persisting uncertainty, and to propose a framework to better define the role of HIPEC in the treatment of peritoneal malignancies.
随着医生们的认识不断提高以及放射成像技术的改进，腹膜腔越来越被认为是各种恶性肿瘤的重要转移部位。由于包括手术切除或全身治疗在内的传统治疗相对无效，这些患者的预后通常较差。腹腔内给药化疗药物被认为是一种有吸引力的替代方法，因为这会使肿瘤组织浓度高而全身暴露有限。添加热疗旨在增强化疗的抗肿瘤作用，从而产生了热灌注腹腔化疗（HIPEC）的概念，用于治疗腹膜转移瘤，该概念大约在30年前就已形成。随着经验的增加，HIPEC已成为全球许多中心提供的一种安全且被认可的治疗方法。然而，该技术的标准化程度较差，临床试验结果也不明确。因此，HIPEC在治疗腹膜转移瘤方面的真正价值仍存在争议。本综述旨在对理论概念以及临床前和临床研究结果进行批判性概述，概述持续存在不确定性的领域，并提出一个框架以更好地界定HIPEC在治疗腹膜恶性肿瘤中的作用。
