OBJECTIVETo evaluated the safety and efficacy of hyperthermic intraperitoneal perfusion chemotherapy(HIPC) in the prevention and treatment of pseudomyxoma peritonei (PMP) recurrence after cytoreductive surgery(CRS).

METHODSStudies published in English before 2010 on HIPC after CRS for PMP were searched in PubMed database. Each study was carefully evaluated based on pre-determined criteria. Study results were comprehensively displayed in a form. A descriptive systematic review was performed.

RESULTSA total of 11 studies were included. The median survival time of patients in these studies ranged from 25.6 months to 156 months. The ranges of 1-year, 2-year, 3-year, 5-year, and 10-year survival rates were 72%-100%, 55%-96%, 59%-96%, 52%-96%, and 55%-96%, respectively. The overall complication rate ranged from 2%-15%, and the total perioperative mortality were from 0 to 7%.

CONCLUSIONHIPC after CRS is effective and safe for patients with PMP.

Chemotherapy, Cancer, Regional Perfusion ; methods ; Humans ; Peritoneal Neoplasms ; drug therapy ; surgery ; Postoperative Care ; Pseudomyxoma Peritonei ; drug therapy ; surgery ; Treatment Outcome

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy (HAIC) has been reported as an effective treatment for advanced hepatocellular carcinoma. The aim of this study is to compare the effect and safety between a high-dose regimen (750 mg/m2 5-fluorouracil [FU] and 25 mg/m2 cisplatin on day 1–4) and a low-dose regimen (500 mg/m2 5-FU on day 1–3 with 60 mg/m2 cisplatin on day 2). METHODS: A total of 48 patients undergoing HAIC were retrospectively analyzed. Thirty-two patients were treated with the high-dose and 16 patients with the low-dose regimen. RESULTS: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease were noted in one (3.1%), 15 (46.9%), three (9.4%), and 13 patients (40.6%) in the highdose group, and 0 (0%), one (6.3%), eight (50%), and seven patients (43.8%) in the low-dose group (P=0.002). The disease control rate (CR, PR, and SD) did not differ between groups (59.4% vs. 56.3%, P=1.000), but the objective response rate (CR and PR) was significantly higher in the high-dose group (50.0% vs. 6.3%, P=0.003). The median progression free survival did not differ between groups (4.0 vs. 6.0, P=0.734), but overall survival was significantly longer in the high-dose group (not reached vs. 16.0, P=0.028). Fourteen (43.8%) patients in the high-dose group and two patients (12.5%) in the low-dose group experienced grade 3–4 toxicities (P=0.050). CONCLUSIONS: High dose HAIC may achieve better tumor response and may improve overall survival compared to a low-dose regimen. However, the high-dose regimen should be administered cautiously because of the higher incidence of adverse events.
Administration, Metronomic ; Carcinoma, Hepatocellular ; Chemotherapy, Cancer, Regional Perfusion ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Humans ; Incidence ; Retrospective Studies

OBJECTIVETo evaluate the efficacy of early continuous hyperthermic peritoneal perfusion (CHPP) on patients of advanced gastric carcinoma after surgical resection.

METHODSSeventy patients were divided into control and treatment group. Patients in treatment group received CHPP 1 or 2 days postoperatively. Treatment was administered daily consecutively for 4 days. Patients in control group underwent resection of gastric carcinoma without CHPP. Chemotherapy was administered of Calcium Folinate and 5-Fluorouracil (LF regimen) intravenously for 6 cycles in both groups two or three weeks postoperatively. Survival and recurrence in both groups were observed and compared.

RESULTSOne-year survival and recurrence rates were 83.3% and 8.3% in treatment group, 79.4% and 11.7% in control group, there were no significant differences between the two groups. Three-year survival and recurrence rates were 63.9% and 19.4 in treatment group, 39.8% and 44.1% in control group, there were significant differences between the two groups.

CONCLUSIONEarly administration of CHPP to patients with advanced gastric carcinoma after surgery may be advantageous for preventing peritoneal metastasis and recurrence, thus may prolong survival time.

Chemotherapy, Cancer, Regional Perfusion ; Female ; Humans ; Hyperthermia, Induced ; Male ; Middle Aged ; Neoplasm Staging ; Perfusion ; Postoperative Period ; Stomach Neoplasms ; drug therapy ; pathology ; Treatment Outcome

Peritoneal carcinomatosis (PC) is one of the difficult problems in the treatment of colorectal cancer (CRC). Based on several retrospective analyses of large samples and prospective randomized controlled studies (RCTs), NCCN and PSOGI recommend cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for selected CRC patients with mild to moderate PC. There are two important controversial issues in this field: the survival benefit of second-look surgery plus HIPEC for the patients with high risk of PC, and the specific benefit of HIPEC added to CRS for patients with PC. PROPHYLOCHIP found that second-look surgery plus HIPEC in patients at high risk of PC does not result in increased survival. PRODIGE 7 showed that overall survival (OS, 41.7 months vs. 41.2 months, P=0.99) and recurrence-free survival (RFS, 13.1 months vs. 11.1 months, P=0.43) were similar between the HIPEC group and non-HIPEC group, and suggested that HIPEC is not necessary for patients who underwent complete CRS. However, due to a series of problems in the design and implementation of this trial, the conclusion has caused great controversy and has not been widely recognized. Through detailed analysis and in-depth discussion, we believe that the benefit of HIPEC could not be denied according to PRODIGE 7. CRS + HIPEC is the embodiment and model of the concept of "Solid tumor treatment is surgery-based integrated treatment". CRS is the cornerstone of therapeutic strategies with curative intent for CRC PC and complete CRS is the key to improve the prognosis. Furthermore, HIPEC is an effective supplement to CRS.
Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Cancer, Regional Perfusion ; Colorectal Neoplasms/therapy* ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Humans ; Hyperthermia, Induced ; Peritoneal Neoplasms/drug therapy* ; Retrospective Studies ; Survival Rate

INTRODUCTIONPatients with peritoneal carcinomatosis (PC) usually have dismal prognoses, even with traditional systemic therapy. Peritonectomy or cytoreductive surgery (CRS) has been used to treat selected patients. It is also commonly used in the management of pseudomyxoma peritonei (PMP), often in combination with hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS AND RESULTSIn the present review article, the indications for CRS and HIPEC are examined, along with its technical aspects, resulting morbidity and mortality. Patients with documented peritoneal carcinomatosis from colorectal and ovarian cancer or PMP, absence of extra-abdominal metastases and liver parenchymal metastases and with an ECOG performance status of <2 should be considered for CRS and HIPEC.

CONCLUSIONIt is important to recognise the role of and indications for CRS and HIPEC. Biologic factors of the disease and completeness of resection are important prognostic factors. Cytoreductive surgery, combined with intraperitoneal chemotherapy, can improve survival in selected patients with peritoneal-based malignancies.

Chemotherapy, Cancer, Regional Perfusion ; Combined Modality Therapy ; Humans ; Hyperthermia, Induced ; Infusions, Parenteral ; Patient Selection ; Peritoneal Neoplasms ; drug therapy ; surgery ; Survival Analysis

OBJECTIVETo compare the clinical effect of postoperative arterial infusion chemotherapy and systemic chemotherapy in gastric cancer.

METHODSFrom July 1997 to July 2002, the patients undergoing radical gastric resection were randomly divided into two groups, and received systemic or arterial infusion chemotherapy three weeks after radical resection. Systemic chemotherapy was carried out for two courses with 5-fluorouracil (5-FU), pirarubicin (THP), and mitomycin (MMC) administered according to FAM program, while arterial infusion chemotherapy for four courses with the same anticancer drugs infused via the celiac artery. The outcomes were compared.

RESULTSSystemic chemotherapy was carried out in 188 cases, and arterial infusion chemotherapy in 180 cases. There were no significant differences in sex, age, tumor location, histological type, TNM stage and surgical procedure between the two groups (P > 0.05). The 1, 3, 5 year survival rates were 87.2%, 53.7% and 43.1% in systemic chemotherapy, and 93.3%, 72.2% and 53.6% in arterial infusion chemotherapy respectively (P< 0.01).

CONCLUSIONThe survival rate of the patients with arterial infusion chemotherapy is higher than that with systemic chemotherapy, which indicates that arterial infusion chemotherapy can remarkably improve the prognosis of the patients with gastric cancer.

Adult ; Aged ; Chemotherapy, Cancer, Regional Perfusion ; methods ; Female ; Humans ; Infusions, Intra-Arterial ; Infusions, Intravenous ; Male ; Middle Aged ; Postoperative Period ; Stomach Neoplasms ; drug therapy

To investigate the role and mechanism of mechanical stress on arterial remodeling, a new model of common carotid artery exposed to stress in vivo was established in rat, in which the change of pressure is the only influencing factor. The effect of high pressure on the morphology and expression of alpha-actin and proliferating cell nuclear antigen (PCNA) of vascular smooth muscle cells (VSMCs) in the artery was assessed. The arteries were perfused by both high pressure (160 mmHg) and normal pressure (80 mmHg) for 6 hours. The changes of morphology, expression of alpha-actin and PCNA in VSMCs were studied by histology and immunohistochemistry. The results showed that the new model could be controlled well in pressure and frequency. The euchromatin was increased and PCNA-positive particles were observed in the nuclei of VSMCs, but the expression of alpha-actin was decreased when the arteries were exposed to the high pressure. The new model has been successfully established, which provides a new tool for studying the effect of mechanical stress on arterial remodeling. In this experiment, VSMCs underwent a transformation from contractile phenotype into synthetic phenotype and tended to proliferate in response to the high pressure.
Actins ; biosynthesis ; Animals ; Carotid Artery, Common ; cytology ; physiology ; Chemotherapy, Cancer, Regional Perfusion ; Male ; Muscle, Smooth, Vascular ; cytology ; Pressure ; Proliferating Cell Nuclear Antigen ; biosynthesis ; Rats ; Rats, Sprague-Dawley

Objective: To explore whether the cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) can improve the survival rate of colorectal cancer patients with peritoneal metastasis. Methods: The relevant studies were systematically retrieved from PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP database, and the study of French Elias' team on peritoneal metastasis was retrieved manually. Inclusion criteria: (1) The patients were colorectal cancer peritoneal metastasis. (2) There were CRS+HIPEC treatments (treatment group) and other treatments (control group). (3) Survival analysis data of treatment group and control group were available. (4) Types of studies were randomized controlled trials, cohort studies, or case-control studies. (5) The literature was in Chinese or English. Exclusion criteria: (1) studies without full-text; (2) studies without complete data. The literature screening and data extraction were carried out by two people independently, and the third person decided on the literature with differences. The extracted data included authors, year of publication, number of patients, time of enrollment, time of follow-up, studies design, treatment regimen, hazard ratio (HR) and 95% CI of treatment group and control groups. If the HR and 95% CI of the treatment group and control group were not provided in the literature, Engauge Digitizer 11.1 software was used to extract the time of follow-up and the survival rate at the corresponding time point from the survival curves of both groups, and the HR and 95% CI of both groups were calculated by combining the number of both groups. The quality of study was evaluated by Newcastle-Ottawa scale (NOS) or Cochrane collaboration's tool for assessing risk bias. STATA 15.1 software was used for statistical analysis. HR and 95% CI of both groups were pooled and analyzed. Inter-trial heterogeneity was assessed by Q test and I(2) statistics. When there was no significant heterogeneity (Q test: P≥0.10), fixed-effect model was used for pooled analysis. When significant heterogeneity existed (Q test: P<0.10), random effect model was used for pooled analysis, and subgroup analysis was used to find out the source of heterogeneity. Sensitivity analysis was used to evaluate the stability of the pooled results. Publication bias was assessed by Egger's test and Begg's test (P<0.05 indicated publication bias) and it is reflected by the visual symmetry of Begg's funnel plot on the natural logarithm of HR. Results: A total of 10 studies were enrolled in the meta-analysis, including 1 randomized controlled trial and 9 cohort studies. The risk of bias in 1 randomized controlled trial was uncertain, and 9 cohort studies were all higher than 7 points, indicating high quality literatures. There were 781 patients in treatment group receiving CRS+HIPEC and 2452 patients in control group receiving other treatment, including tumor cytoreductive surgery (CRS), palliative chemotherapy (PC) and intraperitoneal chemotherapy (IPC). The results of pooled analysis by random effect model showed that the OS rate in treatment group was significantly higher than that in control group (HR=0.43, 95% CI: 0.34-0.54), but the heterogeneity of the study was high (P=0.024, I(2)=52.9%). The subgroup analysis of different control treatments showed that the OS rate in treatment group was significantly higher than that in CRS control group (HR=0.63, 95% CI: 0.44-0.90), in PC control group (HR=0.37, 95% CI: 0.32-0.43), in CRS+ IPC control group (HR=0.60, 95% CI: 0.37-0.96), and the heterogeneity of each subgroup was low (CRS control group: P=0.255, I(2)=22.9%; PC control group: P=0.222, I(2)=29.9%; CRS+IPC control group: P=0.947, I(2)=0). Due to the low heterogeneity of subgroups, fixed-effect models were used to pool and analysis. The results of sensitivity analysis revealed that there was little difference between the pooled analysis results after each study was deleted, suggesting that the pooled analysis results were more reliable. Publication bias detection of each study showed Begg's test (P=0.088) >0.05 and Egger's test (P=0.138)>0.05. According to the Begg's funnel plot, the scatter point distribution was basically symmetric, indicating that there was no publication bias in the included study. Conclusion: CRS+HIPEC can improve the OS of patients with colorectal cancer peritoneal metastasis.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Chemotherapy, Cancer, Regional Perfusion ; Colorectal Neoplasms/therapy* ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Humans ; Hyperthermia, Induced ; Hyperthermic Intraperitoneal Chemotherapy ; Peritoneal Neoplasms/drug therapy* ; Prognosis ; Randomized Controlled Trials as Topic ; Survival Rate

OBJECTIVETo evaluate the clinical effect of intraoperative and early postoperative continuous hyperthermic pertioneal perfusion chemotherapy (CHPPC) for gastric cancer.

METHODSEight-five patients with gastric cancer were randomized into therapeutic group with perioperative CHPPC combined with intravenous chemotherapy (n=44) and control group with intravenous chemotherapy only (n=41). The postoperative complications, adverse effects, local recurrence rates, distant metastasis rates, and 1- and 3-year survival rates were compared between two groups.

RESULTSNo significant differences were found in the postoperative complications and adverse effects between the two groups. The recurrence rate and distant metastasis rates in the therapeutic group were significantly lower than those in the control group (20.45% vs 43.90%, and 15.90% vs 39.02%, P<0.05). The 1- and 3-year survival rates in the therapeutic group were significantly higher than those in the control group (90.90% vs 78.05%, and 59.09% vs 34.15%, P<0.05).

CONCLUSIONPerioperative CHPPC for gastric cancer is safe and feasible, and can reduce the recurrence rate, distant metastasis rate and improve the survival for gastric cancer patient after operation.

Adenocarcinoma, Mucinous ; drug therapy ; surgery ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; Chemotherapy, Cancer, Regional Perfusion ; methods ; Female ; Humans ; Hyperthermia, Induced ; Injections, Intraperitoneal ; Intraoperative Period ; Male ; Middle Aged ; Stomach Neoplasms ; drug therapy ; surgery ; Treatment Outcome

OBJECTIVETo explore the effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) on the postoperative metastatic rate and survival rate of advanced gastric cancer (AGC).

METHODSIn HIIC group, patients received HIIC (mitomycin C 30 mg and cisplatin 100 mg were added into 2000 ml distilled water, heated to 42 approximately 45 degrees C, perfused to abdominal cavity for 30 min and then sucked) and intravenous chemotherapy after operation (5- FU 10 approximately 15 mg/kg, mitomycin C 0.1 approximately 0.15 mg/kg, adriamycin 0.5 approximately 1 mg/kg i.v drip, once a week for 2 approximately 3 weeks). In control group, patients received intravenous chemotherapy only. The postoperative metastatic rate and survival rate (1- , 3- and 5- year) of patients were compared between 92 cases of AGC undergone HIIC and 120 cases of AGC without HIIC (control group).

RESULTSThe peritoneal recurrence rates after operations occurred within two years were 14.1% and 37.5% in HIIC group and control group respectively (P < 0.01). The 1- , 3- , and 5- year survival rates in HIIC group were 98.9%, 68.5%, and 52.2% and in control group 95.0%, 56.7% and 37.5% respectively. The 3- , and 5- year survival rates were significantly different between the two the groups (P < 0.05).

CONCLUSIONHIIC can kill isolated intraperitoneal cancer cells, reduce peritoneal recurrence rate after operations, raise significantly survival rate of patient, and improve the prognosis of AGC.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemotherapy, Cancer, Regional Perfusion ; Cisplatin ; administration & dosage ; Female ; Humans ; Hyperthermia, Induced ; Injections, Intraperitoneal ; Intraoperative Period ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Oxonic Acid ; administration & dosage ; Stomach Neoplasms ; therapy ; Young Adult