Background/objectives:Despite the incremental improvement of survival with systemic therapy in metastatic gastric cancer (GC), the outcomes of patients with peritoneal carcinomatosis (PC) remain poor. The limited effectiveness of systemic therapy is attributed to the blood–peritoneal barrier and anarchic intra-tumoral circulation, which reduce the penetration of systemic therapy. Approaches that incorporate intraperitoneal (IP) chemotherapy, in addition to systemic therapies, may be a viable alternate strategy. Therefore, we provide a review of biology of gastric cancer peritoneal metastasis and evidence for bidirectional iterative IP chemotherapy in GCPC.Methods:A comprehensive search in PubMed, Scopus, Embase, Web of Science, Google Scholar, and ClinicalTrials.gov was performed to find the relevant articles and ongoing phase II/III clinical trials in iterative IP chemotherapy in GCPC.Results:Intraperitoneal (IP) chemotherapy leverages the blood–peritoneal barrier to allow for the administration of high concentrations of chemotherapy directly to the peritoneal metastases, with a significant reduction in the systemic toxicity and enhanced drug efficacy against peritoneal metastasis. This pharmacokinetic advantage of IP chemotherapy can be further enhanced by additional measures such as heat or aerosolization. There are three IP chemotherapy approaches, namely, heated intraperitoneal chemotherapy (HIPEC), pressurized intraperitoneal aerosolized chemotherapy (PIPAC), and normothermic intraperitoneal chemotherapy (NIPEC). Recent evidence suggests that iterative IP chemotherapy combined with systemic therapy may offer significant survival benefits for patients with peritoneal metastasis. Furthermore, bidirectional treatment approaches may also increase the chances of surgical resection and survival.Conclusions:IP chemotherapy plays a pivotal role in the management of gastric carcinomatosis, particularly in combination with cytoreduction in highly selected patients. The combination of systemic and regional control may increase the chances of surgical resection and may ultimately lead to significant survival benefits.
背景/目的：尽管系统性治疗使转移性胃癌（GC）患者的生存期逐步改善，但腹膜癌病（PC）患者的预后仍然较差。系统性治疗疗效有限的原因在于血-腹膜屏障及肿瘤内部无序的血液循环，这些因素降低了系统性治疗的渗透性。在系统性治疗基础上联合腹腔内（IP）化疗可能是一种可行的替代策略。因此，本文综述了胃癌腹膜转移的生物学特性，并探讨了双向迭代腹腔化疗在胃癌腹膜转移中的应用证据。 方法：通过系统检索PubMed、Scopus、Embase、Web of Science、Google Scholar及ClinicalTrials.gov数据库，收集关于胃癌腹膜转移迭代腹腔化疗的相关文献及正在进行的II/III期临床试验资料。 结果：腹腔化疗利用血-腹膜屏障的特性，可将高浓度化疗药物直接作用于腹膜转移灶，在显著降低全身毒性的同时增强对腹膜转移的疗效。通过加热或雾化等辅助手段，可进一步强化腹腔化疗的药代动力学优势。目前腹腔化疗主要分为三种形式：腹腔热灌注化疗（HIPEC）、加压腹腔雾化化疗（PIPAC）以及常温腹腔化疗（NIPEC）。最新证据表明，迭代腹腔化疗联合系统性治疗可为腹膜转移患者带来显著的生存获益。此外，双向治疗策略还可能提高手术切除机会并延长生存期。 结论：腹腔化疗在胃癌腹膜转移的治疗中具有关键作用，特别是在经过严格筛选的患者中联合肿瘤细胞减灭术应用时。系统性治疗与区域控制的联合应用可提高手术切除可能性，并最终为患者带来显著的生存获益。
Iterative Intraperitoneal Chemotherapy in Gastric Cancer Peritoneal Carcinomatosis
肿瘤(癌症)患者之家