Clinical efficacy of type-B ultrasound-guided intraperitoneal hyperthermic chemoperfusion combined with systemic chemotherapy in advanced gastric cancer patients with malignant ascites

Hyperthermic intrathoracic/intraperitoneal chemotherapy versus conventional intrapleural/intraperitoneal chemotherapy for the malignant effusion: a multi-center randomized clinical trial

OBJECTIVE

To compare the efficacy and safety of hyperthermic intrathoracic/intraperitoneal chemotherapy versus conventional intrapleural/intraperitoneal chemotherapy in the treatment of malignant pleural or peritoneal effusion.

METHODS

A randomized clinical trial was carried out in 8 cancer centers across China. Patients with malignant pleural or peritoneal effusion were randomly assigned to the study group or control group. Patients in the study group were treated with cisplatin-based hyperthermic intrathoracic chemotherapy (HITHOC) or hyperthermic intraperitoneal chemotherapy (HIPEC), while the control group was treated with conventional intrapleural or intraperitoneal chemotherapy using same chemotherapeutic regime as the study group. The objective response rate (ORR) was analyzed as primary outcome. Quality-of-life (QOL) score was recorded as secondary outcome using the questionnaire 30 (QLQ-C30) of the European Organization for Research and Treatment of Cancer (EORTC). The efficacy and safety of the two treatments were compared.

RESULTS

Total 135 patients were recruited and randomized in this study, with 67 patients in the study group and 68 patients in the control group. The ORR in the study group (80.70%) was significantly higher than that in the control group (31.03%, p < 0.001). However, neither changes of QOL scores, nor incidence rates of adverse events were significantly different between the two groups (p = 0.076 and 0.197, respectively).

CONCLUSION

Efficacy of HITHOC or HIPEC is superior to that of conventional modality for the treatment of malignant effusion with comparable side effects.

Emission Wavelength Switchable Carbon Dots Combined with Biomimetic Inorganic Nanozymes for a Two-Photon Fluorescence Immunoassay

In this work, o-phenylenediamine is utilized as a precursor to synthesize the fluorescent emission wavelength switchable carbon dots (o-CDs). Our investigation reveals that ferrous ions (Fe²⁺) can effectively induce fluorescence quenching of o-CDs by chelation and aggregation. After the addition of hydrogen peroxide (H₂O₂), the fluorescence of o-CDs recovers and the fluorescent color changes from yellow to green. As far as we know, o-CDs are the first reported CDs with switchable fluorescence emission wavelength. In order to fabricate an enzyme-free immunosensor, an amino-functionalized dendritic mesoporous silica nanoparticle (DMSN)-gold nanoparticle (Au NP) nanostructure was fabricated as a glucose oxidase mimetic nanoenzyme by in situ coating of the Au NPs on the surface of the DMSNs. Then, the functionalized DMSN-Au NPs were modified on the detection antibody and hydrolyzed with glucose to produce H₂O₂. This immune induced recognition strategy combines with the o-CDs+Fe²⁺ signal generation system to achieve specific and sensitive detection of the target. The replacement of glucose oxidase by DMSN-Au NPs not only reduces the cost but also provides significantly amplified signals due to DMSNs haing a high specific surface area. We show the detection of carcinoembryonic antigen (CEA) as an example target to evaluate the analytical figure of merits of the proposed strategy. Under the optimal conditions, two-photon-based o-CDs displayed excellent performances for CEA and the limit of detection as low as 74.5 pg/mL with a linear range from 0.1 to 80 ng/mL. The proposed fluorescent immunosensor provides an optional and potential scheme for low cost, high sensitivity, and versatile discovery of clinical biomarkers.

Effect of hyperthermic intraperitoneal chemotherapy for gastric cancer patients: a meta-analysis of the randomized controlled trials

Objective

To determine the effectiveness and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced gastric cancer and peritoneal metastases.

Methods

PubMed®, CNKI, Web of Science, VIP and WANFANG databases were searched to identify randomized controlled trials (RCTs) that examined the effect of HIPEC on survival, clinical response and adverse events. Patients with advanced gastric cancer and peritoneal metastases were divided into an experimental group and a control group. The statistical results are presented as relative ratio (RR), mean difference (MD) and 95% confidence interval (CI).

Results

Twenty-one RCTs met the inclusion criteria (n = 1674 patients). Meta-analysis showed that the 3-year survival rate was significantly higher in the HIPEC group than in the control group (RR 1.61; 95% CI 1.43, 1.82) and the complete response rate was significantly higher in the HIPEC group than in the control group (RR 2.35; 95% CI 1.67, 3.31). HIPEC was also beneficial in terms of decreased CEA (MD −1.79; 95% CI −2.22, −1.35). There was no significant difference in the rate of adverse reactions (RR 1.00; 95% CI 0.87, 1.14).

Conclusions

HIPEC had a beneficial effect on 3-year survival rate and complete response in patients with advanced gastric cancer and peritoneal metastases.