Abstract:

Treatment strategy for unresectable local advanced gastric cancer from a surgical point of view        LIANG Han. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute & Hospital，National Clinical Research Center for Cancer，Tianjin 300060，China
Abstract    According to Yoshida’s stage IV gastric cancer classification, for some patients with marginally resectable and potentially unresectable metastatic gastric cancer，neoadjuvant intraperitoneal plus systematic chemotherapy (NIPS)，cytoreductive surgery（CRS） plus hyperthermic intraperitoneal chemotherapy (HIPEC)，palliative surgery plus chemotherapy，conversion therapy with docetaxel based three drug regimen and S1/paclitaxel chemotherapy plus apatinib may be benefited. For patients with moderate amount and more ascites，NIPS regimen may control the ascites, relieve symptoms and prolong the survival time. CRS+HIPEC has been demonstrated to provide survival benefit for patients with PCI  (peritoneal cancer index) score≤6. It is still controvertial whether the palliative surgery followed by chemotherapy may benefit for patient or not，but judicious use of surgical resection both gastrectomy and metastasis before chemotherapy in metastatic gastric cancer patients may result in favorable treatment approach. Conversion therapy with docetaxel based three drug regimen and chemotherapy combined with apatinib may result a high conversion rate.

Key words: gastric cancer, unresectable, conversion therapy, cytoreductive surgery (CRS), hyperthermia intraperitoneal chemotherapy( HIPEC)

摘要：

对于潜在可切除的和不可切除的转移性胃癌病例，采取新辅助腹腔+系统化疗（NIPS）、肿瘤细胞减灭术（CRS）+腹腔热灌注化疗（HIPEC）、姑息手术+化疗、以紫杉醇为基础的三药化疗进行转化治疗以及以抗血管生成的靶向药物阿帕替尼联合化疗进行转化治疗可能使部分病人生存获益。NIPS方案针对中等以上腹水病例可以达到控制腹水、缓解症状、延长生存的目的。CRS+HIPEC适用于腹膜癌指数（PCI）≤6的腹膜转移病例。姑息手术+化疗是否可以使病人生存获益尚存争议，但是理性选择病人将原发灶与转移灶同时切除+静脉化疗可以改善其远期生存。以紫杉醇为基础的三药化疗和阿帕替尼联合化疗进行转化治疗似乎可以获得比较高的手术转化率。

关键词: 胃癌, 不可切除, 转化治疗, 细胞减灭术, 腹腔热灌注化疗