Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A bidirectional approach for gastric cancer peritoneal metastasis
Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A bidirectional approach for gastric cancer peritoneal metastasis
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DOI：
10.1016/j.suronc.2020.05.006
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发表时间：
2020-09-01
影响因子：
2.3
通讯作者：
Rotolo, Stefano
中科院分区：
文献类型：
--
作者：
Di Giorgio, Andrea;Schena, Carlo Alberto;Rotolo, Stefano
背景资料：尽管有几项疗效证明试验，但很少有胃癌腹膜转移（GCPM）患者接受局部治疗。加压腹腔内雾化化疗（PIPAC）是近年来出现的一种有前途的工具，以控制腹膜癌转移。PIPAC与全身化疗的结合可能提供比标准治疗更大的临床获益。方法：从2017年9月至2019年9月，28例连续受GCPM影响的患者的单中心队列计划进行双向治疗，包括PIPAC和全身化疗。记录的数据包括安全性、疗效和生存结局。腹水量，腹膜癌指数（PCI）和病理反应，通过腹膜回归分级评分（PRGS）进行了比较，在那些患者谁经历了一个以上的PIPAC procedure.Results：46 PIPAC程序管理，平均1.7 PIPAC程序每例。PIPAC后恢复全身化疗的中位时间为6天（范围4-7）。关于安全性，记录了2起3-4级CTCAE（不良事件通用术语标准v4.0）毒性事件和1起术中并发症。13例患者重复PIPAC。在61.5%的患者中记录了病理学反应（1例完全消退，7例部分消退）。中位总生存期为12.3个月的总体人群和15.0个月的患者接受一个以上的PIPAC procedure.Conclusions：双向的方法GCPM是可行的和安全的，PIPAC程序集成以及与几个全身化疗方案。病理学反应证实了PIPAC的抗肿瘤功效。建议的双向方法可能会进一步研究在一线治疗转移性胃癌。
Background: Few patients affected by gastric cancer peritoneal metastasis (GCPM) are offered locoregional treatment, despite several proof-of-efficacy trials. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged in recent years as a promising tool to control peritoneal carcinomatosis. The combination of PIPAC with systemic chemotherapy may offer a greater clinical benefit than standard treatment alone.Methods: A single-center cohort of 28 consecutive patients affected by GCPM was scheduled for bidirectional treatment, comprising PIPAC and systemic chemotherapy, from September 2017 to September 2019. Data recorded included safety, efficacy and survival outcomes. Ascite volumes, the Peritoneal Cancer Index (PCI) and pathological response through the Peritoneal Regression Grading Score (PRGS) were compared in those patients who underwent more than one PIPAC procedure.Results: Forty-six PIPAC procedures were administered, with a mean of 1.7 PIPAC procedures per patient. The median time to resume systemic chemotherapy after PIPAC was 6 days (range 4-7). Concerning safety, two grade 3-4 CTCAE (Common Terminology Criteria for Adverse Events v4.0) toxicity events and one intraoperative complication were recorded. Thirteen patients repeated PIPAC. A pathological response was recorded in 61.5% of patients (one with complete and seven with partial regression). The median overall survival was 12.3 months in the overall population and 15.0 months in patients undergoing more than one PIPAC procedure.Conclusions: A bidirectional approach for GCPM was feasible and safe, as the PIPAC procedure integrates well with several systemic chemotherapy regimens. The pathological response demonstrated the antitumoral efficacy of PIPAC. The proposed bidirectional approach may be further investigated in the first-line treatment of metastatic gastric cancer.