华西医学

华西医学

胃癌和结直肠癌腹腔热灌注化疗的欧洲临床试验进展

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腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)的应用得到越来越多的尝试,是腹膜表面肿瘤可选择的治疗手段之一。在胃癌和结直肠癌术后辅助 HIPEC 治疗可能预防腹膜复发,或在单纯合并腹膜转移情况下行基于多学科综合治疗模式的肿瘤细胞减灭术+HIPEC 或单纯 HIPEC 治疗可能获得一定效果。在第 11 届国际腹膜表面恶性肿瘤协作组国际会议上,报道了欧洲相关临床试验 GASTRIPEC、GASTRICHIP、PRODIGE 7、PROPHYLOCHIP、COLOPEC、COMBATAC 的进展。上述试验中,目前尚无确定性试验结果支持 HIPEC 治疗可能给胃癌或结直肠癌患者带来生存获益。但远期随访结果尚待观察,而且部分研究尚在招募中。虽然多项研究为Ⅲ期设计,但总体样本量均不大。此外,在试验中可发现诊断性腹腔镜探查在胃癌和结直肠癌病例中推广应用,具有提高分期准确性和优化治疗策略的价值。HIPEC 治疗的适应证(腹膜癌指数)和技术要点(时间、温度、入路、药物)均有待进一步探索。

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in clinical setting, and is one of the optional treatment for peritoneal surface tumors. It can be used as adjuvant therapy to prevent peritoneal recurrence after gastric or colorectal cancer resection, or to treat those diseases with peritoneal metastasis alone through cytoreductive surgery +HIPEC or HIPEC alone, based on a multidisciplinary model. The updates of European HIPEC-related clinical trials, GASTRIPEC, GASTRICHIP, PRODIGE 7, PROPHYLOCHIP, COLOPEC, COMBATAC, were reported at the 11th International Workshop on Peritoneal Surface Malignancy. In those trials, there was no definitive result surporting that HIPEC treatment might bring survival benefits to patients with gastric or colorectal cancer. However, long-term follow-up results remain to be seen, and some studies are still recruiting. Although several studies were designed as phase Ⅲ trials, the overall sample size was small-scaled. In addition, in the trials, diagnostic laparoscopy were widely used in gastric or colorectal cancer patients, which was helpful to improve staging accuracy and optimizing treatment strategies. The indications for HIPEC therapy (peritoneal cancer index) and technical issues (duration, temperature, approach, and agents) need further investigate.

关键词: 胃癌; 结直肠癌; 腹腔热灌注化疗; 肿瘤细胞减灭术; 临床试验

Key words: Gastric cancer; Colorectal cancer; Hyperthermic intraperitoneal chemotherapy; Cytoreductive surgery; Clinical trial

引用本文: 陈心足, 周总光, 胡建昆. 胃癌和结直肠癌腹腔热灌注化疗的欧洲临床试验进展. 华西医学, 2018, 33(12): 1460-1465. doi: 10.7507/1002-0179.201812082 复制

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