| Part oneBackgroundGastric cancer is the fourth most common cancer, with876000new cases (8.7%of the total) and647000deaths (10.4%of cancer deaths) worldwide in year2000. And in China, gastric cancer is linked to high morbidity and mortality. Approximately400000new cases of gastric cancer are diagnosed annually. It is also one of the most common causes of cancer-related death. Patients with an operable tumor have a median survival of less than24months. And most of the gastric cancer patients died of recurrence. Peritoneal recurrence is the worst pattern of relapse. Peritoneal carcinomatosis occurs in as many as20%of gastric cancer patients that explored for potentially curative resection, and40%-60%of these patients only have peritoneum lesions in the first recurrence. With palliative treatment, these patients have a poor prognosis of approximately6-8months survival. Therefore, this is a very urgent that find a way to improve the prognosis of patients diagnosed as gastric cancer.The effect of improving the prognosis of gastric cancer in the combined treatment of radiotherapy, chemotherapy, surgery and immunotherapy. Nowadays, surgery is the dominant position in the treatment of gastric cancer. Some of studies reported that lymphatic metastasis was closely related to the prognosis and recurrence of gastric cancer. Most of surgery suggested that patients should be preformed with elective lymph node dissection. Based on that, D2radicalresection was recommend to surgeons all over the world through NCCN. What’s more, regional recurrence is one of the reasons of operation fails. So radiotherapy is the effective way to prevent regional recurrence. Radiotherapy and interventional radiology treatment can also be used for unresectable advanced gastric cancer or component part of resectable cancer. Due to gastric carcinoma operation treatment effect is not good. A lot of new auxiliary treatment method is proposed to be used for clinical, chemotherapy is one kind of new adjuvant therapy. At the present stage, chemotherapy is generally divided into preoperative chemotherapy and postoperative chemotherapy. Surgeons debated the effect of chemotherapy on gastric cancer after study in the past, some of a skeptical, some of a positive attitude to the postoperative chemotherapy. Because of the side effect of chemotherapy, the effect of chemothearpy is not ideal, some scholars believe that immune function is damage. To enhance immunity in chemotherapy and increase the curative effect, The immune therapy is recommend. The treatment has improved to a certain extent of the effect, but peritoneal metastasis of gastric cancer limites efficacy. To deal with this new problem, scholars have put forward the concept of intraperitoneal chemotherapy. Fisher’s study confirmed that primary tumor cells would occur dynamic change after surgery.Because of cell proliferation rate increase and the load reduce, a large number of GO phase cells proliferated, and accelerates proliferation. A week after the growth is visible to the naked eye tumor. Primary tumor resection after7days, the residual cancer cells are much more sensitive to chemotherapy in abdominal cavity, when is the ideal time for chemotherapy. The intraperitoneal chemotherapy is the easiest way to chemotherapy.Hyperthermic intraperitoneal chemotherapy is the earliest way of chemotherapy. The synergistic effect between hyperthermia and chemotherapy increase the ability of killing tumor cells what improve the effect of operation. Intraperitoneal hyperthermic perfusion chemotherapy not only can be used for the treatment of patients with malignant ascites, but also the patients with the highest survival period may be extended for up to35months. Intraperitoneal hyperthermic perfusion chemotherapy has been proved to be feasible and safe by clinical studies and meta-analyses. HIPEC is a new treatment with the exact effect.ObjectiveTo evaluate the curative efficacy of hyperthermic intraperitoneal perfusion followed by intravenous chemotherapy versus intravenous chemotherapy alone in patients diagnosed as advanced gastric cancer. Clinical study of intraperitoneal hyperthermic perfusion combined with intravenous chemotherapy in treatment of both multiple organ and peritoneum metastasis of advanced gastric cancer. Methods23patients were assigned to two groups:10patients were treated with HIPEC followed by intravenous chemotherapy (Treatment group); and13patients were treated with intravenous chemotherapy alone(Control group). The time to progression (TTP),quality of life, complications and overall survival (OS)were compared between the two groups. The treatment group was inserted four large bore catheters through the abdominal wall incision, one below the right lobe of the liver, one below the spleen and two in the pelvis. The abdominal skin will be closed and the catheters connected to a perfusion circuit. Patients completed the first session of HIPEC in the operating room under general anesthesia. The other parts were performed in the intensive care unit after the operation. HIPEC was performed3-5times every patients. At every session,0.9%saline solution(3000-4000ml) as perfusion liquid. Then HIPEC was performed for60min with a velocity of 400ml/min and an inflow temperature43℃. Both of two groups received intravenous chemotherapy.ResultsThe average duration of follow-up was8months while the longest follow-up time of15months in this study. At3-month follow-up, there were six patients with disease progress in treatment group and nine in control group. At6months follow-up, there were80%patients with disease progress in treatment group and0in control group. At1year follow-up, there were all of patients with disease progress. There was no significant difference between two groups(P=0.131).At3-month follow-up, there were two patients died of advanced gastric cancer in control group. At6months follow-up, the survival rate was90%in treatment group and46%in control group. At the end of follow-up, all patients died of cancer. There was significant difference between treatment group and control group(P=0.016).The common adverse effects were bone marrow suppression and digestive reaction.3patients were suspected incomplete intestinal obstruction and spontaneous remission with time. There were1patient with drug fever and1patients with aplastic anemia. There was no significant difference between two groups(P=0.77).The treatment group had3cases improved,1cases of illness, no other changes. The control group had5cases of illness, no improvement. The improve the situation of the two groups were statistically analyzed, P<0.05had statistical significance, evaluation of quality of life of the two groups had significant difference. After the treatment, the treatment group on the improvement of quality of life than the control group.ConclusionsIn conclusion, HIPEC followed by intravenous chemotherapy leads to superior overall survival and quality of life as compared with simple intravenous chemotherapy. Further clinical studies,based on larger cohorts of patients, are required to definitively assess the role of HIPEC followed by intravenous chemotherapy in the treatment of peritoneal and multiple organ metastasis.Part twoBackgroundColorectal cancer is a common malignant tumor of digestive tract, the world’s third largest cancer. Although the combined therapy based on operation, supplemented by neoadjuvant therapy has become a new trend in the treatment of colorectal cancer, but the overall treatment effect is not satisfied. In patients with colorectal cancer,40%cancer patients died of cancer recurrence or metastasis. The best way to prevent tumor recurrence or metastasis was carried out chemotherapy as soon as possible. The earliest start of chemotherapy for the operation carried out in intraperitoneal chemotherapy. Fluorouracil sustained release implants is one of the commonly used way of intraperitoneal chemotherapy recently. Short term efficacy and safety of fluorouracil sustained release implants have been made in the relevant documents. The clinical curative effect of long-term on the advanced application of intraoperative has been controversial.ObjectiveTo investigate the clinical effect of fluorouracil sustained release implant intraperitoneal chemotherapy in the treatment of advanced colorectal cancer.Methods99Patients with stage II or III colorectal cancer were divided into intra-peritoneal implantation chemotherapy group and control group. Intra-peritoneal implantation chemotherapy group received implantation of fluorouracil sustained-release implant in the surgical fields after digestive continuity reconstruction, while the control group only received routine management during radical operation. Radical operation for colorectal cancer in experimental group standard, including colorectal cancer Dixon operation, before abdominal closure implant600mg evenly sprinkle on the tumor bed, tumor foci and suspected subclinical lesions, such as the superior mesenteric artery, side. Rectal cancer patients implanted on the pelvic sidewall lateral ligament attachment, bladder side clearance, the obturator vessels around the iliac vessels, around, around inferior mesenteric artery and abdominal aorta in surrounding tissues. After implantation, the implant was fixed with gelatin sponge, in case the medicine logistics loss. Both treatment group and the experiment group underwent systemic chemotherapy. Relapse rate and disease-free survival were compared between the two groups.ResultsBy the end of follow-up, the experimental group had9patients with recurrent relapse, the control group had7cases of recurrence. In experimental group,8patients had liver metastasis. Recurrence of the two groups had significant difference, the control group compared with the treatment group is high recurrence. Vascular invasion may have higher liver metastases. In the experimental group, vascular invasion of the liver metastasis rate is higher. In the two group are postoperative vascular invasion cases, compared the liver metastasis. There was significant difference, the difference may be due to effects induced by fluorouracil sustained release implants. The experimental group’s survival was higher than that in control group.ConclusionsFluorouracil sustained release implants is curative effect in routine postoperative intraperitoneal implantation. This study demonstrates that the application of fluorouracil sustained release implants can reduce colorectal cancer recurrence rate, plays an important role in improving the quality of operation, and liver metastasis rate. But it needs reliability of large scale randomized multicenter controlled study the conclusion. |
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