PERITONEAL CARCINOMATOSIS FROM GASTRIC CANCER

Ann Surg Oncol. 2013 Dec 20. [Epub ahead of print]

Outcome Data of Patients with Peritoneal Carcinomatosis from Gastric Origin Treated by a Strategy of Bidirectional Chemotherapy Prior to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Single Specialized Center in Japan.

Canbay E, Mizumoto A, Ichinose M, Ishibashi H, Sako S, Hirano M, Takao N, Yonemura Y.

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Abstract

BACKGROUND:

Management of peritoneal disseminated gastric cancer (GC) remains a challenging problem. The purpose of our study was to evaluate the outcome of bidirectional induction chemotherapy [bidirectional intraperitoneal and systemic induction chemotherapy (BIPSC)] in patients with peritoneal carcinomatosis (PC) arising from GC who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

PATIENTS AND METHODS:

Overall, 194 patients with PC arising from GC were treated with BIPSC comprising intraperitoneal docetaxel at a dose of 20 mg/m2 and cisplatin at a dose of 30 mg/m2 followed by four cycles of oral S-1 at a dose of 60 mg/m2. CRS and HIPEC were performed in responders to BIPSC.

RESULTS:

Of these 194 patients, 152 (78.3 %) underwent CRS and HIPEC between January 2005 and December 2012. Treatment-related mortality was 3.9 %, and major complications occurred in 23.6 % of patients. The median survival rate was 15.8 months, with 1-, 2-, and 5-year survival rates of 66, 32 and 10.7 %, respectively, in the patients treated with combined treatment. Multivariate analysis identified pathologic response to BIPSC (p = 0.001), low tumor burden [peritoneal cancer index (PCI) ≤ 6] (p = 0.001), and completeness of CRS (CC-0, CC-1) (p = 0.001) as independent predictors for a better prognosis.

CONCLUSION:

As a viable option, BIPSC with CRS and HIPEC for patients with PC arising from GC may be performed safely, with acceptable morbidity and mortality, in a specialized unit. Response to BIPSC, optimal CRS and limited peritoneal dissemination seem to be essential to achieve the best outcomes in these patients.