腹膜转移癌腹腔化疗的创新与挑战  

Innovations and challenges in intraperitoneal chemotherapy for peritoneal metastatic carcinoma

作　　者：冯欣滢 王冰 刘培峰[1,2] FENG Xinying;WANG Bing;LIU Peifeng(State Key Laboratory of Systems Medicine for Cancer,Shanghai Cancer Institute,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200032,China;Central Laboratory,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院,上海市肿瘤研究所,肿瘤系统医学全国重点实验室,上海200032 [2]上海交通大学医学院附属仁济医院中心实验室,上海2000127

出　　处：《中国癌症杂志》2024年第9期827-837,共11页China Oncology

基　　金：国家自然科学基金面上项目(32371468)。

摘　　要：腹膜转移癌是指从原发部位扩散至腹膜的恶性肿瘤,常见于胃癌、结直肠癌、卵巢癌及腹膜假黏液瘤(pseudomyxoma peritonei,PMP)等多种癌症类型的晚期阶段。腹膜转移癌的复发率和死亡率高,严重危害人类健康,通常在根治术后或晚期腹膜转移阶段采用以化疗为主的姑息性治疗方案。腹膜转移癌治疗的难点在于缺少靶向治疗药物以及药物较难透过血-腹膜屏障,以致全身治疗效果欠佳。腹腔化疗(intraperitoneal chemotherapy,IPC)作为一种重要的临床治疗手段,在腹膜转移癌的治疗中具有广阔的应用前景。近年来,腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)、腹腔加压气溶胶(pressurized intraperitoneal aerosol chemotherapy,PIPAC)等IPC技术的革新和新型药物的出现显著延长了患者的生存期。然而,腹膜转移癌的多样性和复杂性使临床IPC在给药方式、药物类型和剂量等治疗策略上仍然存在差异性和疗效不确定性。尽管已经制定了基于循证医学证据的指南和推荐治疗策略,但是仍需要通过更多的临床试验和更高级别的循证医学证据来进一步支持这些方案。本文对IPC的发展历程和最新进展进行归纳总结,对比分析手术治疗联合传统IPC、HIPEC及PIPAC等治疗手段的疗效,并对近期开展的IPC技术的研究进展进行汇总。此外,在IPC技术的临床应用方面,本文详细阐述其在胃癌、结直肠癌、妇科肿瘤、PMP、胆管癌及胰腺癌等疾病中的应用。针对IPC技术的局限性,提出纳米药物的创新开发有望为腹膜转移癌的治疗提供更安全有效的选择。综上所述,本文通过梳理IPC研究的最新进展、不足和未来发展方向,以期为腹膜转移癌更有效的临床治疗提供可行性方向。Peritoneal metastatic carcinoma refers to the spread of malignant tumors from the primary site to the peritoneum.It is commonly observed in the advanced stages of various cancer types,including gastric cancer,colorectal cancer,ovarian cancer and pseudomyxoma peritonei(PMP).Peritoneal metastatic carcinoma seriously impair human health due to their high recurrence and mortality rates,and palliative treatment based on chemotherapy is usually provided after radical surgery or in the advanced stage of peritoneal metastases.The difficulties in the treatment of peritoneal metastatic carcinoma are the lack of targeted drugs and the difficulty of drugs to cross the blood-peritoneal barrier,resulting in poor systemic effects.Intraperitoneal chemotherapy,as an important therapeutic means,has a broad application prospect in the treatment of peritoneal metastatic carcinoma.In recent years,innovations in intraperitoneal chemotherapy techniques such as hyperthermic intraperitoneal chemotherapy(HIPEC),pressurized intraperitoneal aerosol chemotherapy(PIPAC)and the development of novel drugs have significantly improved patients'quality of life.The development of novel drugs has significantly improved patient survival.However,the diversity and complexity of these diseases have led to clinical variability and uncertainty in the efficacy of intraperitoneal chemotherapy in terms of treatment strategies such as mode of administration,drug type and dose.Although evidence-based guidelines and recommended treatment strategies have been developed,there is a need to further support these regimens through additional clinical trials and higher levels of evidence-based medicine.This review summarized the development history and recent advances in intraperitoneal chemotherapy,compared and analyzed the treatments such as surgery combined with traditional IPC,HIPEC and PIPAC,and summarized the research progress of recently conducted intraperitoneal chemotherapy techniques;moreover,in terms of the clinical application of intraperitoneal chemothera

关 键 词：腹膜转移癌 腹腔化疗 腹腔热灌注化疗 腹腔加压气溶胶 纳米药物 靶向治疗 

分 类 号：R730.53[医药卫生—肿瘤]