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雙向性化學治療
Bidirectional Chemotherapy

傳統的全身性化學治療,藥物打入血管中,隨著血液循環流動到身體各部位,並滲透到組織中。即使是口服化學治療藥物也是屬於全身性化學治療的一種。其中共同的缺點,就是藥物到達腹腔中的濃度都很低,對於轉移到腹腔中的癌細胞,毒殺作用非常有限。

 

 

而腹腔內的化學治療,因為腹腔內的濃度很高,對於轉移到腹腔中的癌細胞,毒殺效果較好。然而對於存在組織中的癌腫瘤,毒殺作用也非常有限。

 

 

如果腹腔轉移的癌細胞已經播種附著在腹膜或腸系膜或任何器官表面,經過一段時間的生長,會生長(向下扎根)到深層組織,而同時存在腹腔表面及組織深部的現象。這時候不論是單獨使用腹腔內化療(毒殺暴露於腹腔表面的腫瘤部分)或全身性化療(毒殺在組織中的腫瘤部分),都無法達到滿意的效果。相反的,這時候如果同時使用腹腔內化療合併全身性化療,預計將可以達到較理想的治療效果。這種方式就是內外夾攻的概念,就稱為雙向性化學治療(Bidirectional Chemotherapy)。

 

 

 

 

如果疾病在初診斷時,就已經是比較嚴重的腹腔轉移狀態,也無法利用腫瘤減量手術(CRS)合併腹腔熱化療(HIPEC)達到理想狀態,我們就會利用雙向性化學治療,待狀況改善後,再實施腫瘤減量手術(CRS)合併腹腔熱化療(HIPEC)。這時候的雙向性化學治療,又稱為雙向性誘導化學治療 (Bidirectional Intraperitoneal and Systemic Induction Chemotherapy, BISIC)。

 

 

然而也不是每位病人都有機會接受雙向性化學治療。如果腹腔內腫瘤生長太過於嚴重,無法讓腹腔內化療的藥物順利滲透到所有腹腔表面,則治療效果一定不好,就不一定要接受雙向性化學治療。而接受雙向性誘導化學治療之後,如果腫瘤反應不佳,也無法進一步接受腫瘤減量手術 (CRS) 合併腹腔熱化療(HIPEC)。

 

 

我們目前已利用此方式實施於一些病人。其中有幾位病人都是原先被一些醫院認定為無法治療,經過雙向性誘導化學治療後,順利接受腫瘤減量手術 (CRS) 合併腹腔熱化療 (HIPEC),目前皆無再發現象,狀況相當理想。



In traditional systemic chemotherapy, the drugs were given into the blood vessels and were transport to every part of the body, then into the organs and tissues. Oral intake of chemotherapeutic agent, is also a form of systemic chemotherapy. In systemic chemotherapy, the concentration of these drugs is very low in the peritoneal cavity. This makes a poor result of cytotoxic effect to the cancer cells within the peritoneal cavity.

In intraperitoneal chemotherapy, the drug concentrations within the peritoneal cavity is very high, which makes a significant cytotoxic effect to the cancer cells within the peritoneal cavity. However, the drugs within the peritoneal cavity was poorly absorbed into tissues, the cytotoxic effect to the cancers within the tissue is very poor.

Once the intraperitoneal cancer cells implant at the peritoneal surface, mesenteric surface or organ surface, after a period, these cancers will invade into the tissue and continue to grow into the deep tissues. It is, the cancers are present in the deep tissues and present at the peritoneal surface. In this condition, to use intraperitoneal chemotherapy alone (to kill the peritoneal surface cancers) or to use systemic chemotherapy alone (to kill the deep tissue cancers), will not reach a satisfied result.
However, if we use intraperitoneal chemotherapy as well as systemic chemotherapy simultaneously, a better result is predicted. It is killing cancers from outside and inside of the tissues, and is also called bidirectional chemotherapy.

If severe peritoneal metastasis is noted at the initial diagnosis, it is impossible to perform cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), we can apply bidirectional chemotherapy first. After a few cycles of bidirectional chemotherapy, if the disease condition improved, then we can perform CRS and HIPEC. In this condition, the bidirectional chemotherapy is also called BISIC (Bidirectional Intraperitoneal and Systemic Induction Chemotherapy)。

However, not every patient is suitable for bidirectional chemotherapy. If the disease is too far advanced, the infused intraperitoneal drugs cannot be distributed evenly within the peritoneal cavity, the result of intraperitoneal chemotherapy will be limited. Bidirectional chemotherapy is not suitable for this condition. Furthermore, after a few cycles of bidirectional chemotherapy, if the disease condition is not improved, then CRS and HIPEC are not indicated.

We applied BISIC in some cases. They were suggested to receive palliative or supportive care by other physicians at other hospitals. After a few cycles of BISIC, some of them received CRS and HIPEC smoothly and survived till now without any evidence of disease recurrence. This is an encouraging fact to us.

 

更新日期 (Update on)  2020-03-08           08:00-17:00  *** Tel: (02)29307930 分機: 8104 許秘書 *** (+886)229307930 Ext. 8104 Miss Hsu ******