scholarly journals Surgical Treatment of Peritoneal Carcinomatosis from Gastric Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kiran K. Turaga ◽  
T. Clark Gamblin ◽  
Sam Pappas
Keyword(s):  
Gastric Cancer ◽  
Surgical Treatment ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Disease Process ◽  
Novel Therapies ◽  
Targeted Agents ◽  
Fatal Disease

Peritoneal carcinomatosis from gastric cancer is considered a fatal disease with limited treatment options. Recent advances in the understanding of the disease process, systemic chemotherapy, and application of cytoreductive surgery and hyperthermic chemoperfusion have shown promising results in the management of this difficult disease. Novel therapies such as extensive intraperitoneal lavage and intraperitoneal targeted agents are being applied in the management of this disease. We review the current literature in this field and describe the rationale behind some of these advances.

scholarly journals Cytoreductive Surgery for Peritoneal Carcinomatosis from Gastric Cancer: Technical Details

2021 ◽  
Vol 10 (22) ◽  
pp. 5263
Author(s):  
Thomas Boerner ◽  
Pompiliu Piso
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Postoperative Morbidity ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Locoregional Treatment ◽  
Surgical Expertise ◽  
Technical Details

Due to limited systemic treatment options, peritoneal carcinomatosis of gastric origin is still associated with a dismal outcome and is claimed a terminal disease. In the past, surgery had not been considered as a potential treatment option. However, there is emerging evidence that in selected patients, locoregional treatment modalities including cytoreductive surgery of peritoneal carcinomatosis can improve survival in patients with gastric cancer. These operative procedures are complex and challenging, and a high surgical expertise of the treating physician is necessary to prevent major postoperative morbidity and mortality with a delay of further systemic therapy. This review summarizes our current knowledge and personal experience regarding the techniques of cytoreductive surgery for peritoneal metastasis of gastric origin.

scholarly journals Gastric cancer: modern approaches and prospects of treatment for peritoneal carcinomatosis (literature review)

2022 ◽  
Vol 20 (6) ◽  
pp. 104-113
Author(s):  
V. A. Markovich ◽  
S. A. Tuzikov ◽  
E. O. Rodionov ◽  
N. V. Litvyakov ◽  
N. O. Popova ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Antitumor Agents ◽  
Peritoneal Cancer Index ◽  
Abdominal Cavity ◽  
Cochrane Library

Gastric cancer (gc) is one of the most common cancers worldwide. The majority of newly diagnosed gastric cancer cases present with distant metastases. Peritoneal carcinomatosis (pc) is the most unfavorable type of progression of primary gc, which occurs in 14–43 % of patients. The purpose of the study was to highlight modern approaches to the treatment of gc with pc. Material and methods. We analyzed 136 publications available from pubmed, medline, cochrane library, and elibrary databases. The final analysis included 46 studies that met the specified parameters. Results. The modern approaches to the treatment of gc with peritoneal carcinomatosis were reviewed, namely: cytoreductive surgery (crs), combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (crs/hipec); neoadjuvant intraperitoneal/systemic chemotherapy (nips) and pressurized intraperitoneal aerosol chemotherapy (pipac). The results of large randomized trials and meta-analyses were analyzed. Benefits and limitations of these trials were assessed. Conclusion. The peritoneal cancer index (pci) and the level of cytoreduction are two key prognostic factors for increasing the median overall survival. By reducing tumor volume through cytoreductive surgery, it is possible to allow tumor cells to re-enter the proliferative phase of the cell cycle and make them more sensitive to antitumor agents. The hematoperitoneal barrier is the main reason that prevents the effective delivery of drugs from the systemic bloodstream to the abdominal cavity, which is why the effect of systemic chemotherapy on peritoneal metastases is extremely limited. Intraperitoneal chemotherapy offers a more effective and intensive regional therapy, creating a so-called «depot» of a chemotherapy drug, thereby prolonging the effect of the administered drugs. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (crs + hipec) using the combination of surgical resection, cytotoxic chemotherapy, hyperthermic ablation of the tumor and hydrodynamic flushing, is a promising approach in the treatment of gc with peritoneal carcinomatosis.

Cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC): Toxicity, survival, and prognostic variables in 130 patients with peritoneal carcinomatosis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15040-15040
Author(s):  
W. Ceelen ◽  
M. Peeters ◽  
P. Houtmeyers ◽  
C. Breusegem ◽  
F. De Somer ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Ovarian Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Dismal Prognosis ◽  
Extent Of Disease

15040 Background: Peritoneal carcinomatosis (PC) has a dismal prognosis. Cytoreductive surgery with HIPEC has been introduced in the management of PC with biologically favourable features. Methods: In an eight year period, 130 patients were treated (53% female, mean age 56±1 years). The origin of PC was colorectal cancer (CRC, 58%), pseudomyxoma peritonei (PMP, 9%), ovarian cancer (17%), primary peritoneal mesothelioma (10%) and gastric cancer (6%). Surgery was followed by HIPEC with mitomycin C (90 min, 35 mg/m2), oxaliplatin (30 min, 460 mg/m2) or cisplatin (90 min, 100–250 mg /m2) depending on tumour histology and previous systemic chemotherapy. The extent of disease was scored using a scale ranging from 0–9, while completeness of cytoreduction (CC) was scored as complete (CC0), nearly complete (CC1, miliary residual disease) or incomplete (CC2, gross residual disease). Target intraperitoneal temperature was 41°C-42°C. Actuarial survival was calculated using the Kaplan Meier method and univariate analysis performed using the log rank method. Results: Open perfusion (coliseum technique) was used in 41% of procedures. Macroscopically complete resection was achieved in 41%. Postoperative 30 day mortality was 1.5% while major morbidity developed in 18% of patients. Morbidity was mainly related to the extent of surgery. Median overall survival (months) was as follows: CRC, 20; PMP, 38; ovarian cancer, 19; gastric cancer, 10; mesothelioma, 9. Median survival was significantly better in CC0 patients (40 months) compared to CC1 (17 months) or CC2 (12 months). Survival was significantly worse in patients with ascites at surgery (p<0.02) and in patients who did not receive adjuvant systemic chemotherapy (p<0.001). The extent of disease score before surgery (p=0.29), performance of a splenectomy (p=0.65), and timing of PC (metachronous or synchronous, p=0.25) were not significantly related to overall survival. Conclusions: Cytoreduction followed by HIPEC offers a significant survival advantage in selected patients with PC with acceptable early toxicity. Survival is significantly associated with disease histology, CC, presence of ascites and adjuvant chemotherapy. No significant financial relationships to disclose.

scholarly journals Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

2016 ◽  
Vol 1 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Claramae Shulyn Chia ◽  
Ramakrishnan Ayloor Seshadri ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Current Evidence ◽  
Term Survival ◽  
Crs And Hipec

AbstractBackground: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer.Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer.Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.

Advances in Treatment Options for High-grade Glioma - Current Status and Future Perspectives

2010 ◽  
Vol 5 (1) ◽  
pp. 49 ◽  
Author(s):  
Ryan T Merrell ◽  
Eudocia C Quant ◽  
Patrick Y Wen ◽  
◽  
◽  
...  
Keyword(s):  
Anaplastic Astrocytoma ◽  
Brain Tumours ◽  
Treatment Options ◽  
High Grade Glioma ◽  
Current Status ◽  
High Grade ◽  
Novel Therapies ◽  
Targeted Agents ◽  
Future Perspectives ◽  
Primary Brain Tumours

High-grade gliomas, including glioblastoma, anaplastic astrocytoma, anaplatic oligodendroglioma and anaplastic oligoastrocytoma, account for the majority of malignant primary brain tumours diagnosed in adults. The prognosis for these tumours is poor despite multimodality therapy with surgery, radiation and/or chemotherapy. This review summarises treatment options for high-grade glioma, including standard regimens, targeted agents and novel therapies.

Two Decades of Progress in the Management of a Rare Disease—Peritoneal Mesothelioma

2015 ◽  
Vol 11 (01) ◽  
pp. 67
Author(s):  
Paul H ugarbaker ◽  
Keyword(s):  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Management Plan ◽  
Regional Chemotherapy ◽  
Peritoneal Mesothelioma ◽  
Perioperative Chemotherapy ◽  
Term Survival ◽  
Peritoneal Space

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare but aggressive disease with a poor sustained response to systemic chemotherapy. Historically, the median survival has been less than 1 year. The disease rarely disseminates outside of the peritoneal space suggesting that local-regional treatment options may be effective in the long-term control of this malignancy. Establishment of a referral center to concentrate experience with the management of this disease has contributed greatly to progress in its management.Materials and methods:Through a series of Institutional Review Board-approved protocols, a long-standing morbidity/mortality assessment, numerous manuscripts published in the peer-reviewed literature, and participation in numerous national and international workshops, a new standard of care with expectations of long-term survival in a majority of patients has evolved.Results:The surgery for this disease has evolved through a sequence of peritonectomy procedures and visceral resections whose goal is to remove all visible evidence of disease. The first step in successful treatment is a complete cytoreduction. After the cancer resection in the operating room, hyperthermic perioperative chemotherapy (HIPEC) is used. A three-drug protocol combines heat-augmented chemotherapy within the peritoneal space and systemic chemotherapy that is heat-augmented as a continuous infusion intravenously. Catheters are placed for early postoperative intraperitoneal chemotherapy using paclitaxel for 5 days. Also placed at the time of the cytoreductive surgery is an intraperitoneal port for long-term combined intraperitoneal and systemic chemotherapy using cisplatin and pemetrexed for 6 months. Patients having the long-term bidirectional chemotherapy have shown statistically significant improved survival compared with those patients who had surgery alone plus the perioperative chemotherapy. There have been no mortality and the grade 4 adverse events have been prospectively accumulated as 12 %.Conclusions:With continued effort, the surgery and long-term regional chemotherapy for DMPM has continued to improve over 20 years. Currently, a management plan that involves cytoreductive surgery, perioperative chemotherapy, and long-term bidirectional chemotherapy has changed the natural history of this disease. A global registry has been initiated to confirm the benefits of these extended treatments.

Advances in Treatment Options for High-grade Glioma—Current Status and Future Perspectives

US Neurology ◽  
2010 ◽  
Vol 06 (01) ◽  
pp. 55 ◽  
Author(s):  
Ryan T Merrell ◽  
Eudocia C Quant ◽  
Patrick Y Wen ◽  
◽  
◽  
...  
Keyword(s):  
Brain Tumors ◽  
Anaplastic Astrocytoma ◽  
Treatment Options ◽  
High Grade Glioma ◽  
Multimodality Therapy ◽  
Current Status ◽  
High Grade ◽  
Novel Therapies ◽  
Targeted Agents ◽  
Future Perspectives

High-grade gliomas, including glioblastoma, anaplastic astrocytoma, anaplatic oligodendroglioma, and anaplastic oligoastrocytoma, account for the majority of malignant primary brain tumors diagnosed in adults. The prognosis for these tumors is poor despite multimodality therapy with surgery, radiation, and/or chemotherapy. This article summarizes treatment options for high-grade glioma, including standard regimens, targeted agents, and novel therapies.

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