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開催概要
開催回
第58回・2020年・京都
 

腹膜播種陽性胃癌に対する経静脈・腹腔内併用化学療法 -10余年間の成果-

演題番号 : WS20-3

[筆頭演者]
蜂谷 修:1 
[共同演者]
石神 浩徳:2、大森 健:3、小寺 泰弘:4、藪崎 裕:5、福島 亮治:6、今野 元博:7、門脇 重憲:8、富田 寿彦:9、秀村 晃生:10、有上 貴明:11、廣野 靖夫:12、辻 靖:13、楠本 哲也:14、北山 丈二:15

1:山形大学・消化器・乳腺甲状腺・一般外科、2:東京大学附属病院・外来化学療法部、3:大阪国際がんセンター・消化器外科、4:名古屋大学・消化器外科、5:新潟県立がんセンター新潟病院・消化器外科、6:帝京大学・外科、7:近畿大学・外科、8:愛知県がんセンター病院・薬物療法部、9:兵庫医科大学・消化器内科、10:関東労災病院・外科、11:鹿児島大学・消化器・乳腺甲状腺外科、12:福井大学附属病院・消化器外科、13:斗南病院・腫瘍内科、14:九州医療センター・消化管外科・がん臨床研究部、15:自治医科大学附属病院・臨床研究センター

 

Background: We have developed a multidisciplinary treatment with intraperitoneal (ip) and systemic chemotherapy, combined with gastrectomy after response. Here we report the results of clinical trials completed from 2006 to 2018 and a retrospective study of surgery after chemotherapy. Material and methods: We performed phase I clinical trials of five combination chemotherapy regimens: S-1/paclitaxel (PTX) plus ip PTX, S-1/oxaliplatin plus ip PTX, S-1/cisplatin plus ip PTX, capecitabine/cisplatin plus ip docetaxel (DOC), and FOLFOX plus ip PTX. We completed phase II clinical trials of three regimens and a phase III PHOENIX-GC trial comparing S-1/PTX plus ip PTX with standard systemic chemotherapy. Additionally, we retrospectively evaluated the safety and efficacy of gastrectomy. Results: In phase I trials, recommended doses of weekly ip PTX and ip DOC were determined to be 20-40 mg/m2 and 10 mg/m2, respectively. In phase II trials, the 1-year overall survival rates were 72%-78%, and the negative conversion rates on peritoneal cytology were 68%-86%. PHOENIX-GC trial narrowly failed to show statistical superiority of S-1/PTX plus ip PTX over S-1 plus cisplatin (p=0.080; hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.49-1.04), although the exploratory analysis adjusting for the baseline imbalance in the amount of ascites between the arms suggested clinical benefits (HR 0.59, 95% CI 0.39-0.87). Out of 222 patients treated with ip chemotherapy in three trials, 93 patients (42%) underwent gastrectomy after disappearance or shrinkage of peritoneal metastasis. The median survival times of patients with surgery were 26.3 months (95% CI 21.3-34.2 months). Postoperative complications of Clavien-Dindo grade II-IVa occurred in 10 patients, with no treatment-related deaths. Conclusions: Multidisciplinary treatment with ip and systemic chemotherapy combined with gastrectomy after response is safe and effective for gastric cancer patients with peritoneal metastasis.

キーワード

臓器別:胃・十二指腸

手法別:化学療法

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