腹腔内全身新辅助化疗(双向化疗)对胃癌腹膜转移癌患者的疗效研究

Effects of Neoadjuvant Systemic/Intraperitoneal Chemotherapy(Bidirectional Chemotherapy)on Peritoneal Carcinomatosis of Gastric Cancer

目的:建立联合腹腔内-全身新辅助化疗方案(NIPS)和腹膜切除术的新型多学科交叉治疗模式。方法:2004年4月至2011年12月本研究纳入来自日本大阪草津综合病院和岸和田综合病院的胃癌腹膜转移癌患者96例,在NIPS治疗前后,均通过腹腔导管系统进行了腹腔冲洗液细胞学检查。患者每日按60 mg/m^2剂量口服S-1,持续21天,随后休息一周;在第1、8、15 d,分别通过腹腔导管给予多西他赛30mg/m^2和顺铂30mg/m^2(500mL生理盐水稀释)。术前行2个周期NIPS。NIPS后3周,82例患者符合意向性细胞减灭术(CRS),即进行胃切除术+D2根治术+腹膜切除术获得完全细胞减灭。结果:68例在NIPS之前细胞学检查阳性,其中47例(69.1%)在NIPS之后细胞学检查阴性,30例(36.8%)在NIPS治疗后达到病理学完全缓解,12例(14.6%)患者达到肿瘤分期下降,58例(70.7%)达到完全细胞减灭。9例患者出现4级并发症,总体手术死亡率为3.7%(3/82)。多变量分析显示,完全细胞减灭和病理缓解是改善患者生存的独立预后因素。结论:该疗法的最佳适应症为病理缓解良好,PCI评分≤6,预期可以通过腹膜切除术达到完全细胞减灭。

Objective：This study aimed to develop a novel multidisciplinary treatment strategy combining neoadjuvant intraperi -toneal-systemic chemotherapy protocol （NIPS） and peritonectomy. Methods：Gastric cancer patients with peritoneal carcinomatosis （PC） （ n=96） were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. For systemic chemo -therapy, the patients were treated with 60mg/m2 of oral S- 1 for 21d, followed by a 1-week rest. For intraperitoneal chemotherapy, 30mg/m2 of Docetaxel and 30mg/m2 of cisplatin with 500 mL of saline were introduced through the port on d 1, 8, and 15. Two cycles of the NIPS regimen was conducted before surgery. Three weeks after NIPS, 82eligible patients underwent complete cytoreductive sur-gery （CRS） by gastrectomy plus D 2 dissection and peritonectomy. Results：Positive cytologic result was observed in 68patients treated with peritoneal washing before NIPS. The number was reduced to 47（69.1%） after NIPS. After NIPS, complete pathologic response on PC was observed in 30（36.8% ） patients. Reduction of tumor stages occurred in12patients （ 14.6% ）. Complete cyto-reduction was achieved in 58of the total patients （70.7%）. Grade4 toxicities occurred in 9 cases, and the overall perioperative mortality rate was 3.7% （3/82）. By multivariate analysis, complete cytoreduction and pathologic response were found to be independent factors for achieving a satisfactory survival rate. Conclusion：The optimal candidates for such multidisciplinary approach are patients with favorable patholog -ic response and PCI ≤6, among whom complete CRS could be achieved with peritonectomy.