胃肠肿瘤根治术后腹腔热灌注化疗结合高频热疗序贯静脉化疗与单纯静脉化疗的对比研究

A comparative study of hyperthermic intraperitoneal chemoperfusion plus high-frequency diathermic therapy followed by intravenous chemotherapy versus intravenous chemotherapy alone after radical operation of gastrointestinal cancer

目的:探讨胃肠肿瘤根治术后腹腔热灌注化疗联合高频热疗序贯静脉化疗对比单纯静脉化疗的疗效和安全性。方法:2005年4月—2010年4月接受胃肠肿瘤根治术的52例患者,其中25例于术后接受了腹腔热灌注化疗联合高频热疗序贯静脉化疗(治疗组),另27例接受了单纯静脉化疗(对照组)。腹腔热灌注化疗方案为顺铂(100mg/m2)+5-氟尿嘧啶(3g/m2),分成3次剂量,分别于第1、5和9天进行腹腔热灌注化疗。比较2组的不良反应、疾病进展时间和总生存期。结果:治疗组术后1年和40个月的无进展率分别为72.0%和54.0%,中位疾病进展时间为40.1个月;对照组的术后1年和40个月无进展率分别为65.8%和11.5%,中位疾病进展时间为18.5个月。治疗组的中位疾病进展时间较对照组明显延长(P=0.027)。治疗组的术后1年和20个月的总生存率分别为88.0%和78.0%;对照组的1年和20个月的总生存率分别为92.6%和72.7%。2组的生存率比较,差异无统计学意义(P=0.108)。2组的化疗不良反应和并发症差异也无统计学意义。结论:胃肠肿瘤根治术后行腹腔热灌注化疗联合高频热疗序贯静脉化疗与单纯静脉化疗的不良反应和并发症发生率相似,至疾病进展时间明显延长。

Objective： To evaluate the curative efficacy and the toxicity of hyperthermic intraperitoneal chemoperfusion （HIPEC） plus high-frequency diathermic therapy followed by intravenous chemotherapy versus intravenous chemotherapy alone after radical operation of gastrointestinal cancer. Methods： Fifty- two patients with gastrointestinal carcinoma receiving radical operation between April 2005 and April 2010 were recruited in this study. These 52 patients were assigned to two groups： 25 patients were treated with HIPEC plus high-frequency diathermic therapy followed by intravenous chemotherapy （study group）; and 27 patients were treated with intravenous chemotherapy alone （control group）. The HIPEC regimen included cisplatin 100 mg/m2 plus 5-fluorouracil 3 g/m2 divided by three times administered at dl, d5 and d9, respectively. The adverse reactions, time to progression （TTP） and overall survival （OS） were compared between the two groups. Results： The postoperative one-year and 40-month progression- free survival rates in the study group were 72.0% and 54.0%, respectively; and the median TTP was 40.1 months. The postoperative one-year and 40-month progression-free survival rates in the control group were 65.8% and 11.5%, respectively; and the median TTP was 18.5 months. The median TTP in the study group was longer than that in the control group （P = 0.027）. The postoperative one-year and 20-month OS rates were 88.0% and 78.0% respectively in the study group, which in the control group were 92.6% and 72.7%, respectively. There was no significant difference in OS between the two groups （P = 0.108）. No statistically significant differences were found in the adverse reactions and complications between the two groups （P〉0.05）. Conclusion： In patients with gastrointestinal cancer after radical operation, HIPEC plus high-frequency diathermic therapy followed by intravenous chemotherapy leads to superior TTP as compared with intravenous chemotherapy only; meanwhile, no more complications and adverse reactions are observed.