编者按：2023年中国整合肿瘤学大会（CCHIO）于11月16～19号在天津举行，在国际专场二——Unit 1上，埃及开罗大学国家癌症研究所的Gamal Amira教授带来了“HIPEC Versus Systemic Chemotherapy in Recurrent Platinum——Sensitive Ovarian Cancer——NCI Cairo University Case Control Study”的报告，报告结束后，Gamal Amira教授接受了肿瘤瞭望的采访，就埃及卵巢癌的诊疗现状及HIPEC对比全身化疗治疗复发铂敏感卵巢癌的结果进行了介绍。

 

Gamal Amira教授：在埃及，所有类型的癌症都有综合治疗手段。我们有国家癌症研究所和南埃及癌症研究所等大约12个癌症中心通过各种手段治疗癌症。卵巢癌约占埃及恶性肿瘤的2%。2021年埃及新诊断的卵巢癌患者约为2600例，几乎与子宫内膜癌相当。因为卵巢癌缺少特异性症状，大多数卵巢癌病例发现时已为晚期。

 

疾病初期女性只会出现腹胀等腹部不适症状，这多数是由于恶性肿瘤所致，而这些症状也常常被忽略。当肿瘤已经扩散到肠道或膀胱或达到很大体积时，患者才意识到要去医院接受治疗。这就是通常大约80%的女性卵巢癌病例初诊时已经是Ⅲ期或者Ⅳ期，也就是疾病晚期的原因。

 

当卵巢癌患者就诊时，她们通常是由妇科、外科等科室转过来的，我们可以发现她们和其他患者的腹部有明显的区别。所以把患者转诊到专科中心，比如国家癌症研究所，在那里我们会对患者进行全面的问诊和检查，如实验室检查、影像学检查等。

 

为了使患者接受最好的治疗，所有的癌症中心和妇科肿瘤中心都会建立专业委员会进行治疗决策，之后患者可能会接受化疗或立即进行手术。手术后，医生会根据患者的病理和分子分型决定患者接受何种治疗。

 

我们中心采用腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）技术治疗卵巢癌。HIPEC是指将含化疗药物的灌注液精准恒温、循环灌注、充盈腹腔并循环灌注一定时间，通过化疗、热疗协同作用和机械冲洗的综合作用，达到预防和治疗恶性肿瘤的腹膜、网膜等腹腔种植转移的一种治疗手段。主要用于低级别腹膜假黏液瘤和间皮瘤，此外，它在结直肠癌中被大规模使用。

 

当前，HIPEC也被用于卵巢癌患者的治疗，但并不是所有的中心都同意应用此治疗方案。关于HIPEC在卵巢癌患者病例中的应用存在争议，但我认为HIPEC对于卵巢癌患者来说是有益的。这种治疗手段主要作用于腹膜，如低级别腹膜假黏液瘤和间皮瘤，因为肿瘤扩散是沿着腹膜而不是直接扩散到结直肠或胃。

 

在埃及大约有八台HIPEC仪器。2011年，我们将第一台HIPEC仪器引进到国家癌症研究所，随后，开罗的一些医院和开罗以外的两个癌症中心也引进了相关的设备。埃及东部比西部地区更多的将HIPEC用于腹膜肿瘤的治疗，最初我们使用HIPEC的思路是，腹腔热灌注化疗不会像全身化疗那样被血液吸收，因为腹膜屏障的存在，腹膜也不具有渗透性，无法将药物输送到血液循环中，所以我们也只会在腹膜腔集中使用这一减少化疗毒性的方案。由于神经毒性在全身治疗中有副作用，患者经常因麻木和神经毒性而烦恼。

 

Oncology Frontier:Could you introduce the current status of ovarian cancer diagnosis and treatment in Egypt?

 

Yeah.In Egypt，there is a comprehensive treatment for all types of cancer.We have the National Cancer Institute and South Egypt Cancer Institute and about 12 other cancer centers specialized to treat cancer by all means.Ovarian cancer represents about 2%of malignancy in Egypt.About 2，600 cases were reported in 2021 and it is almost equal to endometrial carcinoma.The diagnosis，you know，most of cases of ovarian cancer present late because the symptoms are non-specific.

 

Iadies only have some abdominal discomfort due to distension，mostly due to acytus or malignant tumors.They present when they are late，when the disease has already spread to involve intestine or bladder or reached a big size.That’s how Usually，ladies present with ovarian cancer and that’s why it is always late and that’s why about 80%of the cases present in stage 3 and stage 4，which are the late stages of the disease.

 

When the patient comes to the service，usually it is referred from gynecologic surgeons or from abdominal physician who has discovered that the patient has a cytosine and marked distinction of the abdomen.So he referred her to the specialized centers like the National Cancer Institute，where we do complete investigation and complete examination for the patient and after completion of the investigation，radiology，laboratory，etc.

 

We have a committee that makes a decision.for the best treatment for the patient.And this is also done in all cancer centers and all centers of gynecologic oncology in the universities.And the patient after that might receive chemotherapy or may go immediately to surgery.And after surgery，of course，the pathology and the molecular pathology will determine what type of treatment the patient will receive after that.We have the technology of HIPEC and HIPEC is heated intrapiratoneal chemotherapy that is used primarily in primary peritoneum tumor like pseudomyxoma peritoneum and mesosilioma and it was used on a larger scale in colorectal cancer.

 

And it is used also in ovarian cancer，but this is not agreed upon by all centers.And there is controversy about the uses of HIPEC in these cases.I think it might be beneficial because the disease is primarily peritoneum tumor and it is logic that this is like Pseudonexoma or like primary mesosilioma tumors because the spread is along the peritoneum more than the colorectal or the stomach.

 

We have about eight machines in Egypt.First of them was in the National Cancer Institute since 2011.And other devices or machines are present in some of the hospitals in Cairo and in two centers outside Cairo，one in Egypt.Ismaili govern rate in the east and the one in Daman Hore Cancer Center in the west and I think more machines are going to be brought for the peritoneal tumors.The idea of using the hyperthermic intraperitoneal chemotherapy is that the chemotherapy would not be absorbed via blood like the systemic chemotherapy and the peritoneum is not permeable to deliver the drug to the circulation because there is a plasma peritoneal barrier.So there will be concentration in the peritoneal cavity only and this will reduce the toxicity of chemotherapy which is the main concern.of the patient because neuro-texicity in the systemic therapy has a bad effect and the patient is always annoyed from the numbness and the neuro-toxicity and other toxicities.

 

Gamal Amira教授：实际上，我报道的这项病例对照研究的研究对象是一小部分患者，HIPEC组入组了15名患者，全身化疗组入组了20名患者。结果显示，与全身化疗相比，腹膜内化疗没有任何优势。但由于患者数量有限，在本研究中，HIPEC组唯一的改善或唯一的收获是减少了全身化疗带来的的神经毒性和不良反应。虽然HIPEC组的无进展生存（PFS）或总生存（OS）获益更好，但与全身化疗相比PFS或OS没有显著的统计学差异。可能是由于研究入组的患者病例数少，它没有显示出生存获益或改善，所以我们今后要开展更多相关的研究。

 

Oncology Frontier:What do you think are the advantages of HIPEC compared to systemic chemotherapy?What are the results and implications of the case-control study you presented at this congress?

 

Actually，our study was on a small number of patients，15 patients versus 20 patients.And it showed no advantage for users of intra-peridineal versus the systemic chemotherapy.Of course，in both cases，we have done complete site reduction.But the number is limited.The only improvement or the only gain of HIPEC in this study was the less incidence of neuro-toxicity and site effects of chemotherapy.It didn’t show a significant effect on the progressive free survival or overall survival，though they were better in the HIPEC group.But maybe due to a small number of cases，it did not show beneficial or improvement.So we are going to do a study on a more skill.

 

Gamal Amira教授

National Cancer Institute-NCI-Cairo University.