Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer
Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer
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DOI：
10.4251/wjgo.v2.i2.85
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发表时间：
2010-02-15
影响因子：
3
通讯作者：
Li, Yan
中科院分区：
文献类型：
--
作者：
Yonemura, Yutaka;Elnemr, Ayman;Li, Yan
胃癌引起的腹膜癌（PC）没有标准的治疗方法。提出了一种结合双向化疗[新辅助腹腔-全身化疗方案（NIPS）]、腹膜切除术、高热腹腔化疗灌流（HIPEC）和术后早期腹腔化疗的新型多学科治疗方法。本文就该疗法的适应症、安全性和有效性进行评价，并对相关研究进行综述，介绍我们的经验。NIPS的目的是减少分期，根除腹膜游离癌细胞，增加PC的完全细胞减少（CC-0）发生率。30例PC患者中有15例（50%）在NIPS后获得完全缓解。因此，在腹膜癌指数(PCI) = 6的患者中，CC-0的发生率明显较高。使用多变量分析来检查生存获益，CC-0和NIPS被确定为良好结局的重要指标。然而，与腹膜切除术和围手术期化疗相关的高发病率和死亡率使得严格的患者选择非常重要。多学科治疗的最佳适应症是可切除的胃癌的局部PC (PCI = 6)，可以在腹膜切除术中完全切除。NIPS和完全细胞减少是提高胃癌PC患者生存率的基本治疗方式。(C) 2010年白石登。版权所有。
There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer. A novel multidisciplinary treatment combining bidirectional chemotherapy [neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)], peritonectomy, hyperthermic intraperitoneal chemoperfusion (HIPEC) and early postoperative intraperitoneal chemotherapy has been developed. In this article, we assess the indications, safety and efficacy of this treatment, review the relevant studies and introduce our experiences. The aims of NIPS are stage reduction, the eradication of peritoneal free cancer cells, and an increased incidence of complete cytoreduction (CC-0) for PC. A complete response after NIPS was obtained in 15 (50%) out of 30 patients with PC. Thus, a significantly high incidence of CC-0 can be obtained in patients with a peritoneal cancer index (PCI) = 6. Using a multivariate analysis to examine the survival benefit, CC-0 and NIPS are identified as significant indicators of a good outcome. However, the high morbidity and mortality rates associated with peritonectomy and perioperative chemotherapy make stringent patient selection important. The best indications for multidisciplinary therapy are localized PC (PCI = 6) from resectable gastric cancer that can be completely removed during a peritonectomy. NIPS and complete cytoreduction are essential treatment modalities for improving the survival of patients with PC from gastric cancer. (C) 2010 Baishideng. All rights reserved.