Intraperitoneal hyperthermic perfusion chemotherapy of patients with chemotherapy-resistant peritoneal disseminated ovarian cancer
Intraperitoneal hyperthermic perfusion chemotherapy of patients with chemotherapy-resistant peritoneal disseminated ovarian cancer
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DOI：
10.1046/j.1525-1438.2001.11(suppl.1)sup1057.x
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发表时间：
2001-01-01
影响因子：
4.8
通讯作者：
Strama, H
中科院分区：
文献类型：
--
作者：
Hager, ED;Dziambor, H;Strama, H
本文旨在通过一项前瞻性、开放性的临床试验，评估腹腔温热灌注化疗（IPHC）对晚期腹膜播散性卵巢癌患者生存和生活质量的可行性和有效性。它们的选择是基于它们在用抗肿瘤（多种化疗抗性或难治性）剂进行不同的全身治疗后的进展。在首次IPHC之前给予的平均化疗周期数为12.5。患者的平均Karnofsky体能状态为60%，36例患者中有17例在IPHC前有腹水。腹腔灌洗溶液的输入温度为48-49 ℃：腹腔内温度为42-43 ℃。用于热交换的溶液的流速为190-220 ml/min，在大于或等于42 ℃的温度下治疗持续1 h。从首次疾病诊断（1stDx）开始的中位总生存时间（MOS）为49 +/-8个月，从首次IPHC治疗开始为19 +/-4个月。所有患者从首次IPHC开始观察到的1年总生存率（OSR）为65 +/-8%，5年OSR为16 +/-7%。恶性腹水在3-5个IPHC内消失。生活质量可以得到改善。与全身化疗相比，不良反应轻微。在162次治疗中，有3次出现腹膜功能紊乱伴肠梗阻症状，我们得出结论：IPHC在技术上是可行的，安全的，并且与生存期的显著延长和生活质量的改善相关。即使是经过大量预治疗的患者也可以安全地接受治疗。一些患者即使在25次IPHC治疗后也对IPHC有反应。根据这些结果，可以得出结论，IPHC也可以改善卵巢癌患者的治疗结果，作为挽救治疗，二线治疗，甚至作为诱导化疗后的巩固或维持治疗，对次优的III期和IV期疾病的患者。这应该在随机对照研究中得到证明。
The purpose of this article is to evaluate in a prospective, open-label clinical trial the feasibility and efficacy of intraperitoneal hyperthermic perfusion chemotherapy (IPHC) on the survival and quality of life of patients with advanced, peritoneal disseminated ovarian cancer.Thirty-six patients with ovarian cancer were accrued for the study, their selection being based on their progression following different systemic therapies with anti-neoplastic (multiple chemotherapy-resistant or -refractory) agents. The average number of chemotherapy cycles given before the first IPHC was 12.5. The patients' average Karnofsky-performance status was 60% and 17 out of 36 patients had ascites before IPHC. The input temperature of the solution for abdominal lavage was 48-49 degreesC: the intraperitoneal temperature was 42-43 degreesC. The flow-rate of the solution for heat exchange was 190-220 ml/min with treatment lasting 1 h at temperatures greater than or equal to 42 degreesC.Median overall survival time (MOS) from first diagnosis of disease (1stDx) was 49 +/-8 months and from the first IPHC-treatment 19 +/-4 months. The observed 1-year overall survival rate (OSR) of all patients from the start of the first IPHC was 65 +/-8% and the 5-year OSR was 16 +/-7%. Malignant ascites vanished within less than 3-5 IPHCs. Quality of life could be improved. The adverse effects were mild especially compared to systemic chemotherapy. In 3 out of 162 treatments, peritoneal disturbances with symptoms of subileus were observed.We conclude that IPHC is technically feasible, safe, and associated with a marked prolongation of survival and improvement in quality of life. Even heavily pretreated patients could be treated safety. Some patients did respond to IPHC even after 25 IPHC treatments. From these results, it can be concluded that IPHC may also improve the treatment outcome of patients with ovarian cancer as salvage therapy, in second-line treatment or even as consolidation or maintenance therapy following induction chemotherapy to patients with suboptimal stage III and IV disease. This should be demonstrated in randomized controlled studies.