Selection criteria for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer

Peritoneal carcinomatosis in gastric cancer is associated with a dismal prognosis.Systemic chemotherapy is not effective because of the existence of a blood-peritoneal barrier.Cytoreductive surgery and intraperitoneal chemotherapy can improve survival and quality of life in selected patients.Patient selection for this multimodal approach is one of the most critical issues,and calls for interdisciplinary evaluation by radiologists,medical and surgical oncologists,and anaesthetists.This article sets forth criteria for selection of gastric cancer patients suffering from peritoneal carcinomatosis.

Experience after 100 patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

AIM:To investigate perioperative patient morbidity/mortality and outcome after cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS:Of 150 patients 100 were treated with cytoreductive surgery and HIPEC and retrospectively analyzed.Clinical and postoperative follow-up data were evaluated.Body mass index(BMI),age and peritoneal carcinomatosis index(PCI) were chosen as selection criteria with regard to tumor-free survival and perioperative morbidity for this multimodal therapy.RESULTS:CRS with HIPEC was successfully performed in 100 out of 150 patients.Fifty patients were excluded because of intraoperative contraindication.Median PCI was 17(1-39).In 89% a radical resection(CC0/CC1) was achieved.One patient died postoperatively due to multiorgan failure.Neither PCI,age nor BMI was a risk factor for postoperative complications/outcome according to the DINDO classification.In 9% Re-CRS with HIPEC was performed during the follow-up period.CONCLUSION:Patient selection remains the most important issue.Neither PCI,age nor BMI alone should be an exclusion criterion for this multimodal therapy.

乌德勒支施源器在宫颈癌3D—IGBT应用观察

目的观察乌德勒支施源器在局部晚期宫颈癌3D—IGBT中的临床应用情况，揭示其在IC—IS的应用规律。方法回顾分析45例接受根治性放疗的局部晚期宫颈癌患者．外照射后行3D．IGBT，其中45例130次IC—IS入组。将满足计划目标剂量分次定义为A组（37例86人次）。余为B组（22例44人次），成组t检验差异。结果施源器使用15、20、25mm卵圆体的频率分别为50．0％、20．0％、30．0％，30mm型号无使用。共置插植针499根，6、7、10、11孔位使用频率分别为23．1％、21．2％、21．2％、24．1％。A组平均插植针数为3．7根明显少于B组4．2根（P=0．008）。A组的HR-CTV平均体积为（40．71±18．43）cm3小于B组（51．81±14．74）cm3（P=0．001），A组HR．CTV的宽和高小于B组（P=0．011、0．006）；而厚相似（P=0．595）。高与插植深度的差两组相似（P=0．366），宽与左右针孔间距的差A组小于B组（P=0．007）。结论局部晚期宫颈癌行IC—IS时．乌德勒支施源器的卵圆体多选用25mm及以下型号，插植孔位多选用6、7、10、11号。在插植针数≥4根、深度≥3cm时，宽度是影响计划剂量的主要因素。