scholarly journals Neoadjuvant systemic and hyperthermic intraperitoneal chemotherapy combined with cytoreductive surgery for gastric cancer patients with limited peritoneal metastasis: a prospective cohort study

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pengfei Yu ◽  
Zeyao Ye ◽  
Gaiguo Dai ◽  
Yanqiang Zhang ◽  
Ling Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Intraperitoneal Chemotherapy ◽  
Peritoneal Metastasis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Palliative Chemotherapy ◽  
Therapy Group ◽  
Conversion Therapy ◽  
Gastric Cancer Patients

Abstract Background There is no currently available treatment for peritoneal metastasis of gastric cancer. This phase II study aimed to evaluate the efficacy and safety of neoadjuvant systemic chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) for the treatment of these patients. Methods Neoadjuvant chemotherapy comprised two cycles of HIPEC and four cycles of S-1 plus paclitaxel. HIPEC was administered intraperitoneally with paclitaxel (75 mg/m2). For systemic chemotherapy, paclitaxel was administered intravenously(150 mg/m2) on day 1, and S-1 was administered orally(80 mg/m2/day)on days 1–14 of a 3-week cycle. Another two cycles of HIPEC and four cycles of S-1 plus paclitaxel were administered after second diagnostic staging laparoscopy or CRS. The primary endpoints were treatment efficiency and safety; the secondary endpoint was 3-year overall survival (OS). Results A total of 40 patients were enrolled and 38 patients have been analyzed. Of these, 18 (47.4%) patients received neoadjuvant systemic chemotherapy, HIPEC and CRS (conversion therapy group), while 20 patients received only chemotherapy and HIPEC (palliative chemotherapy group). Median OS was markedly improved in the conversion therapy group (21.1 months, 95% confidence interval [CI] 16.7–25.6 months) in comparison with the palliative chemotherapy group(10.8 months, 95%CI 7.3–14.2 months, p = 0.002). After neoadjuvant systemic chemotherapy and HIPEC, a second laparoscopic exploration was performed, and the prognosis of patients with low peritoneal cancer index (PCI) (PCI < 6) was significantly better than that of patients with high PCI (PCI ≥ 6)(20.1 vs.11.3 months, p = 0.006). Conclusion Neoadjuvant systemic chemotherapy and HIPEC combined with CRS is safe and feasible, and could potentially improve the prognosis of gastric cancer patients with limited peritoneal metastasis. However, further clinical trials are still warranted. Trial registration This study has been registered with ClinicalTrials.gov as NCT02549911. Trial registration date: 15/09/2015.

scholarly journals Neoadjuvant systemic and hyperthermic intraperitoneal chemotherapy combined with cytoreductive surgery for gastric cancer patients with limited peritoneal metastasis: a prospective cohort study

2020 ◽  
Author(s):  
Pengfei Yu ◽  
Zeyao Ye ◽  
Gaiguo Dai ◽  
Yanqiang Zhang ◽  
Ling Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Intraperitoneal Chemotherapy ◽  
Peritoneal Metastasis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Palliative Chemotherapy ◽  
Therapy Group ◽  
Conversion Therapy ◽  
Gastric Cancer Patients

Abstract Background: There is no currently available treatment for peritoneal metastasis of gastric cancer. This phase II study aimed to evaluate the efficacy and safety of neoadjuvant systemic chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) for the treatment of these patients. Methods: Neoadjuvant chemotherapy comprised two cycles of HIPEC and four cycles of S-1 plus paclitaxel. HIPEC was administered intraperitoneally with paclitaxel (75 mg/m2). For systemic chemotherapy, paclitaxel was administered intravenously(150 mg/m2) on day 1，and S-1 was administered orally（80 mg/m2/day）on days 1-14 of a 3-week cycle. Another two cycles of HIPEC and four cycles of S-1 plus paclitaxel were administered after second diagnostic staging laparoscopy or CRS. The primary endpoint was treatment efficiency and safety; the secondary endpoint was 3-year overall survival (OS). Results: A total of 40 patients were enrolled and 38 patients have been analyzed. Of these, 18 (47.4%) patients received neoadjuvant systemic chemotherapy, HIPEC and CRS (conversion therapy group), while 20 patients received only chemotherapy and HIPEC (palliative chemotherapy group). Median OS was markedly improved in the conversion therapy group (21.1 months, 95% confidence interval [CI] 16.7-25.6 months) in comparison with the palliative chemotherapy group(10.8 months, 95%CI 7.3-14.2 months, p=0.002). After neoadjuvant systemic chemotherapy and HIPEC, a second laparoscopic exploration was performed, and the prognosis of patients with low peritoneal cancer index (PCI) (PCI < 6) was significantly better than that of patients with high PCI (PCI≥6)(20.1 vs.11.3 months, p=0.006). Conclusion: Neoadjuvant systemic chemotherapy and HIPEC combined with CRS was safe and feasible, and could potentially improve the prognosis of gastric cancer patients with limited peritoneal metastasis. However, further clinical trials are still warranted.

scholarly journals Neoadjuvant systemic and hyperthermic intraperitoneal chemotherapy combined with cytoreductive surgery for gastric cancer patients with limited peritoneal metastasis: a prospective cohort study

2020 ◽  
Author(s):  
Pengfei Yu ◽  
Zeyao Ye ◽  
Gaiguo Dai ◽  
Yanqiang Zhang ◽  
Ling Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Intraperitoneal Chemotherapy ◽  
Peritoneal Metastasis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Palliative Chemotherapy ◽  
Therapy Group ◽  
Conversion Therapy ◽  
Gastric Cancer Patients

Abstract Background There is no currently available treatment for peritoneal metastasis of gastric cancer. This phase II study aimed to evaluate the efficacy and safety of neoadjuvant systemic chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) for the treatment of these patients. Methods Neoadjuvant chemotherapy comprised two cycles of HIPEC and four cycles of S-1 plus paclitaxel. HIPEC was administered intraperitoneally with paclitaxel (75 mg/m2). For systemic chemotherapy, paclitaxel was administered intravenously(150 mg/m2) on day 1,and S-1 was administered orally(80 mg/m2/day)on days 1–14 of a 3-week cycle. Another two cycles of HIPEC and four cycles of S-1 plus paclitaxel were administered after second diagnostic staging laparoscopy or CRS. The primary endpoint was treatment efficiency and safety; the secondary endpoint was 3-year overall survival (OS). Results A total of 40 patients were enrolled and 38 patients have been analyzed. Of these, 18 (47.4%) patients received neoadjuvant systemic chemotherapy, HIPEC and CRS (conversion therapy group), while 20 patients received only chemotherapy and HIPEC (palliative chemotherapy group). Median OS was markedly improved in the conversion therapy group (21.1 months, 95% confidence interval [CI] 16.7–25.6 months) in comparison with the palliative chemotherapy group(10.8 months, 95%CI 7.3–14.2 months, p = 0.002). After neoadjuvant systemic chemotherapy and HIPEC, a second laparoscopic exploration was performed, and the prognosis of patients with low peritoneal cancer index (PCI) (PCI < 6) was significantly better than that of patients with high PCI (PCI ≥ 6)(20.1 vs.11.3 months, p = 0.006). Conclusion Neoadjuvant systemic chemotherapy and HIPEC combined with CRS was safe and feasible, and could potentially improve the prognosis of gastric cancer patients with limited peritoneal metastasis. However, further clinical trials are still warranted. Trial registration: This study is registered with ClinicalTrials.gov as NCT02549911, registered on 15 September 2015.

Risk factors for peritoneal carcinomatosis in gastric cancer patients, and outcomes following resection and hyperthermic intraperitoneal chemotherapy (HIPEC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14656-e14656
Author(s):  
Ki Won Kim ◽  
Oliver Chow ◽  
Kunal Parikh ◽  
Sima Blank ◽  
Ghalib Jibara ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Cancer Patients ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Univariate Analysis ◽  
Tumor Stage ◽  
The United States ◽  
Term Survival ◽  
Gastric Cancer Patients

e14656 Background: Gastric cancer (GC) contributes significantly to the burden of cancer death in the United States. Unfavorable prognosis in patients with gastric cancer and peritoneal carcinomatosis (GCPC) is well-documented. In this study, a model predictive of GCPC is proposed, and outcomes in patients with GCPC treated with surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are assessed. Methods: A single-institution analysis of 112 patients treated for GC between the years 2000 and 2011 was performed. Demographic and clinical-pathologic criteria were entered into univariate and multivariate analyses, to identify criteria independently predictive of GCPC. Overall survival in each cohort was determined via Kaplan-Meier analysis. Results: GCPC developed in 28/112 (25%) of GC patients. Several variables were associated with GCPC by univariate analysis (age, p = 0.018; tumor stage, p = 0.004; tumor location, p = 0.046), but only age (≤60) and tumor stage (T3/T4) were independently predictive of GCPC by multivariate analysis (HR = 3.949, p = 0.024; HR = 3.942, p = 0.049, respectively). Intermediate-term survival was not significantly impacted in nine GCPC patients treated with HIPEC (65% 1-year, 39% 3-year without HIPEC; vs. 73% 1-year, 39% 3-year with HIPEC, p = NS). Conclusions: A model to identify gastric cancer patients at highest risk for GCPC is proposed. Although intermediate term survival in a small number of GCPC patients (9) treated with HIPEC is not significantly improved, emerging experience with increased follow-up with HIPEC in larger cohorts is needed. Earlier application of HIPEC targeted at patients at highest risk may be feasible in utilizing a model predictive of GCPC.

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