PDF(Pubmed)
Abstract：
OBJECTIVE: Despite advances in systemic therapy, outcomes of patients with gastric cancer (GC) peritoneal carcinomatosis (PC) remain poor, in part because of poor penetrance of systemic therapy into peritoneal metastasis due to the plasma-peritoneal barrier and anarchic intra-tumoral circulation. Hence, regional treatment approach with administration of chemotherapy directly into the peritoneal cavity (intraperitoneal, IP) under various conditions, combined with or without cytoreductive surgery (CRS) has remained an area of significant research interest. The purpose of this review is to provide high-level evidence for regional treatment approaches in the management of GCPC with limited peritoneal disease.
METHODS: A review of the current literature and ongoing clinical trials for regional IP therapies for GCPC was performed. Studies included in this review comprise of phase III randomized controlled trials, non-randomized phase II studies, high-impact retrospective studies, and active ongoing clinical trials for each available IP modality.
RESULTS: The three common IP approaches are heated intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC) and more recently introduced, pressurized intraperitoneal aerosolized chemotherapy (PIPAC). These IP approaches have been combined with systemic therapy and/or CRS with varying degrees of promising results, demonstrating evidence of improvements in survival rates and peritoneal disease control. Patient selection, optimization of systemic therapy, and completeness of cytoreduction have emerged as major factors influencing the design of contemporary and ongoing trials.
CONCLUSIONS: IP chemotherapy has a clear role in the management of patients with GCPC, and when combined with CRS in appropriately selected patients has the potential to significantly improve survival. Ongoing and upcoming IP therapy clinical trials hold great promise to shape the treatment paradigm for GCPC.
METHODS: A review of the current literature and ongoing clinical trials for regional IP therapies for GCPC was performed. Studies included in this review comprise of phase III randomized controlled trials, non-randomized phase II studies, high-impact retrospective studies, and active ongoing clinical trials for each available IP modality.
RESULTS: The three common IP approaches are heated intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC) and more recently introduced, pressurized intraperitoneal aerosolized chemotherapy (PIPAC). These IP approaches have been combined with systemic therapy and/or CRS with varying degrees of promising results, demonstrating evidence of improvements in survival rates and peritoneal disease control. Patient selection, optimization of systemic therapy, and completeness of cytoreduction have emerged as major factors influencing the design of contemporary and ongoing trials.
CONCLUSIONS: IP chemotherapy has a clear role in the management of patients with GCPC, and when combined with CRS in appropriately selected patients has the potential to significantly improve survival. Ongoing and upcoming IP therapy clinical trials hold great promise to shape the treatment paradigm for GCPC.
摘要：
目的：尽管全身治疗取得了进展，胃癌（GC）腹膜癌（PC）患者的预后仍然很差，部分原因是由于血浆-腹膜屏障和肿瘤内循环无政府状态导致的全身治疗对腹膜转移的渗透性差。因此，局部治疗方法，将化疗直接注入腹膜腔(腹膜内，IP)在各种条件下，联合或不联合细胞减灭术(CRS)仍然是一个值得关注的研究领域.这篇综述的目的是为局限性腹膜疾病的GCPC的区域治疗方法提供高水平的证据。
方法：对目前文献和正在进行的GCPC区域IP治疗的临床试验进行综述。本综述中包括的研究包括III期随机对照试验，非随机II期研究，高影响力的回顾性研究，以及每种可用IP模式的正在进行的积极临床试验。
结果：三种常见的IP方法是加热腹膜内化疗（HIPEC），常温腹腔化疗（NIPEC）和最近推出的，加压腹膜内雾化化疗（PIPAC）。这些IP方法已与全身性治疗和/或CRS相结合，取得了不同程度的有希望的结果。证明生存率和腹膜疾病控制改善的证据。患者选择,系统治疗的优化，和细胞减灭术的完整性已成为影响当代和正在进行的试验设计的主要因素。
结论：IP化疗在GCPC患者的治疗中具有明确的作用，在适当选择的患者中，当与CRS联合使用时，有可能显着提高生存率。正在进行和即将进行的IP疗法临床试验有望为GCPC塑造治疗范式。
方法：对目前文献和正在进行的GCPC区域IP治疗的临床试验进行综述。本综述中包括的研究包括III期随机对照试验，非随机II期研究，高影响力的回顾性研究，以及每种可用IP模式的正在进行的积极临床试验。
结果：三种常见的IP方法是加热腹膜内化疗（HIPEC），常温腹腔化疗（NIPEC）和最近推出的，加压腹膜内雾化化疗（PIPAC）。这些IP方法已与全身性治疗和/或CRS相结合，取得了不同程度的有希望的结果。证明生存率和腹膜疾病控制改善的证据。患者选择,系统治疗的优化，和细胞减灭术的完整性已成为影响当代和正在进行的试验设计的主要因素。
结论：IP化疗在GCPC患者的治疗中具有明确的作用，在适当选择的患者中，当与CRS联合使用时，有可能显着提高生存率。正在进行和即将进行的IP疗法临床试验有望为GCPC塑造治疗范式。
