Background: Peritoneal metastases (PM) represent a common and challenging manifestation of several gastrointestinal and gynecologic malignancies. Bidirectional treatment—combining Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with systemic chemotherapy—has emerged as a strategy to enhance locoregional control while maintaining systemic coverage.Objective: This systematic review aimed to analyze the study design, characteristics, and timing of the treatments administered—including the type of systemic chemotherapy, intraperitoneal agents used in PIPAC, and interval between administrations—as well as the clinical outcomes, safety profile, and overall methodological quality of the available literature on bidirectional treatment for peritoneal metastases.Methods: A systematic literature search was conducted across the PubMed, Embase, and Cochrane Library databases up to April 2025. Studies were included if they reported clinical outcomes of patients undergoing bidirectional treatment. Data extraction focused on survival, response assessment (PRGS, PCI), adverse events, systemic and intraperitoneal regimens, treatment interval, and study methodology.Results: A total of 22 studies involving 1015 patients (742 treated with bidirectional therapy) were included. Median overall survival ranged from 2.8 to 19.6 months, with the most favorable outcomes observed in gastric and colorectal cancer cohorts. PRGS improvement after multiple PIPAC cycles was reported in >80% of evaluable cases. High-grade adverse events (CTCAE ≥ 3) occurred in up to 17% of patients in most studies, with only one study reporting treatment-related mortality. However, methodological quality was generally moderate, with considerable heterogeneity in treatment protocols, response criteria, systemic regimens, and toxicity attribution.Conclusions: Bidirectional therapy with PIPAC and systemic chemotherapy appears to be a feasible and potentially effective strategy for selected patients with peritoneal metastases. Despite encouraging outcomes, definitive conclusions are limited by the retrospective nature and heterogeneity of available studies. Prospective standardized trials are needed to confirm efficacy, clarify patient selection, and optimize treatment protocols.
**背景：** 腹膜转移是多种胃肠道和妇科恶性肿瘤常见且具挑战性的表现。双向治疗——即结合加压腹腔内气溶胶化疗与全身化疗——已成为一种在维持全身覆盖的同时增强局部区域控制的策略。 **目的：** 本系统综述旨在分析关于腹膜转移双向治疗的现有文献的研究设计、特征、治疗时机（包括全身化疗类型、PIPAC中使用的腹腔内药物以及给药间隔），以及临床结局、安全性概况和整体方法学质量。 **方法：** 在PubMed、Embase和Cochrane图书馆数据库中进行系统文献检索，截止日期为2025年4月。纳入报告接受双向治疗患者临床结局的研究。数据提取侧重于生存期、疗效评估（PRGS、PCI）、不良事件、全身和腹腔内方案、治疗间隔和研究方法学。 **结果：** 共纳入22项研究，涉及1015名患者（其中742名接受双向治疗）。中位总生存期范围为2.8至19.6个月，在胃癌和结直肠癌队列中观察到最有利的结局。超过80%的可评估病例报告了在多个PIPAC周期后PRGS得到改善。在大多数研究中，高达17%的患者发生了高级别不良事件（CTCAE ≥ 3级），仅有一项研究报告了治疗相关死亡率。然而，方法学质量普遍中等，治疗方案、疗效标准、全身方案和毒性归因方面存在相当大的异质性。 **结论：** 对于选定的腹膜转移患者，PIPAC联合全身化疗的双向治疗似乎是一种可行且可能有效的策略。尽管结局令人鼓舞，但现有研究的回顾性性质和异质性限制了得出明确结论。需要进行前瞻性标准化试验来确认疗效、明确患者选择和优化治疗方案。
肿瘤(癌症)患者之家