Efficacy of conversion surgery after a single intraperitoneal administration of paclitaxel and systemic chemotherapy for gastric cancer with peritoneal metastasis

Background: The optimal treatment for gastric cancer with peritoneal metastasis (GCPM) remains debatable. This study aimed to compare the efficacy and safety of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) versus neoadjuvant systemic chemotherapy (NSC) for GCPM. Methods: Patients of GCPM received neoadjuvant chemotherapy with docetaxel, oxaliplatin and S-1 between January 2011 and June 2019 were retrospectively evaluated. Propensity score matched (PSM) analysis was carried out to reduce the selection bias. Multivariate Cox regression model was applied to screen the prognostic factors. Results: After PSM processing, 71 patients in each group were matched among the 186 GCPM patients included. NIPS yielded a better ascites and cytology response to chemotherapy, higher conversion resection rate and R0 resection rate than NSC. The overall survival (OS) rate in NIPS group was better than that in NSC group. Multivariate analysis revealed that the P stage, ascites response, conversion surgery rate and R0 resection rate were independent prognostic factors. Subgroup analysis indicated that NIPS showed a survival benefit over NSC only in patients with cT3-4a, P1-2, whose cytology turned negative, and who received conversion surgery; while not in patients with cT4b, P0 or P3, whose cytology did not turn negative, or who did not receive conversion surgery. Conclusions: NIPS is a safe and feasible treatment for GCPM, which showed more benefit than NSC.

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Intraperitoneal administration of a small interfering RNA targeting nuclear factor-kappa B with paclitaxel successfully prolongs the survival of xenograft model mice with peritoneal metastasis of gastric cancer

International Journal of Cancer ◽

10.1002/ijc.23867 ◽

2008 ◽

Vol 123 (11) ◽

pp. 2696-2701 ◽

Cited By ~ 16

Author(s):

Masashi Inoue ◽

Sachiko Matsumoto ◽

Hiroaki Saito ◽

Shunichi Tsujitani ◽

Masahide Ikeguchi

Keyword(s):

Gastric Cancer ◽

Peritoneal Metastasis ◽

Small Interfering Rna ◽

Nuclear Factor Kappa B ◽

Intraperitoneal Administration ◽

Xenograft Model ◽

Nuclear Factor ◽

Nuclear Factor Kappa ◽

Rna Targeting ◽

Interfering Rna

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Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer

Frontiers in Oncology ◽

10.3389/fonc.2020.610572 ◽

2021 ◽

Vol 10 ◽

Author(s):

Linda Feldbrügge ◽

Felix Gronau ◽

Andreas Brandl ◽

Timo Alexander Auer ◽

Alan Oeff ◽

...

Keyword(s):

Gastric Cancer ◽

Systemic Therapy ◽

Peritoneal Metastasis ◽

Systemic Chemotherapy ◽

Postoperative Morbidity ◽

Laparoscopic Technique ◽

Complication Rates ◽

The Mean ◽

Safe Treatment Option ◽

Length Of Interval

BackgroundPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopic technique for local chemotherapy. It has been used for treatment of peritoneal metastasis of gastric cancer (PM GC) in combination with systemic therapy. VEGFR2 antagonist ramucirumab is a second-line therapy for GC, and has been suspected to cause wound healing disorders.MethodsThis is a retrospective single center cohort study of patients with PM GC, who received PIPAC treatment in combination with systemic chemotherapy with and without ramucirumab. Data on patients’ characteristics and their perioperative courses were collected and complication rates were compared with regard to preoperative use of ramucirumab and time between last dose of systemic therapy and PIPAC treatment.ResultsFifty patients underwent 90 PIPAC treatments for PM GC in 3 years. Overall postoperative morbidity was 11% with 6% severe complications. The mean interval between systemic therapy and PIPAC was 20 days. Neither the length of interval nor the use of ramucirumab had an effect on complication rates.ConclusionOur study suggests that addition of ramucirumab to pre-PIPAC systemic therapy, irrespective of the length of the treatment-free interval before PIPAC, does not increase the risk of postoperative complications and is therefore a safe option for treatment of PM GC.

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Bidirectional Systemic Chemotherapy and Pressurized Aerosol Chemotherapy (PIPAC) for Peritoneal Metastasis from Gastric Cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2019.11.367 ◽

2020 ◽

Vol 46 (2) ◽

pp. e139

Author(s):

Andrea Di Giorgio ◽

Stefano Rotolo ◽

Carlo Abatini ◽

Miriam Attalla El Halabieh ◽

Antonia Strippoli ◽

...

Keyword(s):

Gastric Cancer ◽

Peritoneal Metastasis ◽

Systemic Chemotherapy

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Intraperitoneal administration of small interfering RNA targeting nuclear factor kappa B with paclitaxel successfully prolong the survival of murine xenograft with peritoneal metastasis of gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.14678 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 14678-14678

Author(s):

M. Inoue ◽

S. Matsumoto ◽

N. Tokuyasu ◽

H. Saitoh ◽

S. Tsujitani ◽

...

Keyword(s):

Gastric Cancer ◽

Peritoneal Metastasis ◽

Small Interfering Rna ◽

Nuclear Factor Kappa B ◽

Intraperitoneal Administration ◽

Nuclear Factor ◽

Nuclear Factor Kappa ◽

Rna Targeting ◽

Interfering Rna

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Cell-free and Concentrated Ascites Reinfusion Therapy (CART) for management of massive malignant ascites in gastric cancer patients with peritoneal metastasis treated with intravenous and intraperitoneal administration of Paclitaxel with Oral S-1.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.e15042 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. e15042-e15042

Author(s):

Joji Kitayama ◽

Hironori Ishigami ◽

Hironori Yamaguchi ◽

Norio Hanafusa

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Peritoneal Metastasis ◽

Intraperitoneal Administration ◽

Malignant Ascites ◽

Gastric Cancer Patients

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Conversion surgery for advancedgastric cancer with peritoneal metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.450 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 450-450

Author(s):

Masaki Nakamura ◽

Mikihito Nakamori ◽

Toshiyasu Ojima ◽

Masahiro Katsuda ◽

Keiji Hayata ◽

...

Keyword(s):

Gastric Cancer ◽

Peritoneal Metastasis ◽

Median Number ◽

Peritoneal Cytology ◽

Conversion Surgery ◽

Second Look ◽

Grade Ii ◽

Positive Peritoneal Cytology ◽

Number Of Treatment ◽

Type 3

450 Background: Patients with peritoneal metastasis have significantly poor prognosis. We have performed pretherapeutic staging laparoscopy (SL) to diagnose peritoneal metastasis for patients with large type 3, type 4 or serosa-invasive gastric cancer. When peritoneal metastasis disappears by chemotherapy for patients with positive peritoneal cytology (CY1) or peritoneal dissemination (P1), we perform the conversion surgery (CS). Methods: We retrospectively analyzed clinical outcomes of 134 patients with advanced gastric cancer who underwent SL between 2005 from 2016. We examined safety and usefulness of CS for patients with CY1 or P1. Results: CY0P0, CY1P0 and P1 were found in 67, 28 and 39 patients, respectively. The median survival time (MST) of patients with CY0P0, CY1P0 and P1 were 39, 21 and 11 months (CY0P0 vs CY1P0; p = 0.029, CY0P0 vs P1; p<0.001, CY1P0 vs P1; p<0.001). In patients with CY1P0, 20 of 26 patients who received chemotherapy underwent the second look SL, and 14 patients (54%) underwent CS (R0) as peritoneal cytology turned negative. These regimens of chemotherapy were S-1/CDDP (n = 9), Docetaxel/CDDP/S-1 (n = 2), SOX (n = 2) and S-1/Docetaxel (n = 1) and the median number of treatment courses was5courses. The MSTs of patients with or without CS were 40 months and 11 months (p<0.001). Then, there was no difference in overall survival between patients with CS and patients with CY0P0 at the first SL (p = 0.866). All patients with P1received chemotherapy, and 11 of these patients underwent the second look SL. As peritoneal metastasis of 7 patients (18%) disappeared by chemotherapy, they underwent CS (R0). The MSTs of patients with or without CS were 31 months and 9 months (p = 0.026). Regarding complications after CS, surgical-site infection and interstitial pneumonia each occurred in one patient (grade II), and intestinal obstruction (grade IIIa) occurred in one patient. There was no mortality. Conclusions: This study suggests that CS is probably safe and may contribute to improve the survival rate of patients with peritoneal metastasis. Moreover, we developed the NSOX regimen, comprised of a combination nab-paclitaxel, S-1 and oxaliplatin, and have performed a phase I/II trial using the NSOX regimen (UMIN000030909).

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