腹腔热灌注化疗治疗不可切除胃癌恶性腹水的临床研究

Clinical study of HIPEC on unresectable gastric carcinoma with malignant ascites

目的探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)联合XELOX(卡培他滨+奥沙利铂)方案化疗在治疗不可切除胃癌恶性腹水的近期疗效及其毒副作用。方法 2012年1月至2013年12月期间40例合并恶性腹水的晚期胃癌患者,随机分为观察组(20例)和对照组(20例),观察组采用顺铂HIPEC联合XELOX方案治疗,对照组采用XELOX方案化疗,化疗4个周期后比较两组患者腹水控制情况及KPS、血清CEA变化情况,观察比较两组患者化疗不良反应。结果观察组患者临床有效率为70%,明显高于对照组的35%(P=0.027);两组患者治疗后均有不同程度KPS上升及CEA下降,治疗前后比较差异有统计学意义(P<0.01),但两组间比较差异无统计学意义(P>0.05)。问卷调查显示观察组在精神状态、食欲改善及腹胀减轻方面较对照组好(P<0.05);两组患者恶心呕吐、腹泻、神经毒性、口腔黏膜炎以及血液学毒性发生率低,且多表现为Ⅰ、Ⅱ度,两组比较差异无统计学意义(P>0.05)。结论在不可切除胃癌合并恶性腹水的患者中,应用顺铂HIPEC联合XELOX方案全身化疗安全可行,毒副作用小,耐受性好,控制恶性腹水近期疗效确切。

Objective To investigate the short-term efficacy and adverse effects of hyperthermic intraperitoneal chemotherapy(HIPEC) combined with systematic XELOX(capecitabine puls oxaliplatin)chemotherapy for unresectable gastric carcinoma with malignant ascites. Methods Forty unresectable gastric carcinoma patients with malignant ascites admitted in our hospital from January 2012 to December 2013 were randomly divided into two groups, and received only systematic XELOX control group(control group,n=20)and HIPEC combined with systematic XELOX(study group, n=20) for 4 cycles. The remission of ascites,serum CEA levels and adverse effects were compared between the two groups. Results The clinical effetive rate was 70% in the study group and 35% and in the control group respectively(P=0.027). The KPS scores were significantly elevated and the serum CEA levels were significantly reduced after treatment in both groups, but there were no significant differences between the two groups. The mental state, appetite and abdominal distension were improved significantly in the study group compared to the control group(P <0.05). The incidences of adverse events including nausea, diarrhea, neurotoxicity, stomatitis and hematologic toxicity were similar between the two groups. Conclusions HIPEC combined with XELOX is safe and feasible in unresectable gastric carcinoma with malignant ascites. Its adverse effects are endurable and remission of malignant ascites is definitely effective.