Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

Abstract

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective treatment in a variety of cancers with peritoneal carcinomatosis (PC), especially in pseudomyxoma peritonei for which it is the standard of care. The data for gastric cancer are not as conclusive. This review discusses the effect of HIPEC on gastric cancer survival, the importance of patient selection, the effect of HIPEC on gastric cancer morbidity, translational research on HIPEC, and other recent research on HIPEC in the setting of gastric cancer and/or peritoneal metastases. CRS-HIPEC has been shown to be superior to either CRS alone or systemic chemotherapy alone in terms of improving survival. CRS-HIPEC seems to be the best current treatment for patients with gastric cancer and peritoneal metastases. The international community has recommended it as the treatment for this disease. Prudent patient selection before CRS-HIPEC is recommended as subgroups of patients have been shown to benefit from the treatment, while others have not. Studies on CRS-HIPEC have shown the procedure to have acceptably low rates of morbidity and peri-and postoperative complications as well as significant reductions in the incidence of ascites associated with PC. Translational research on HIPEC supports its use as prophylaxis for prevention of peritoneal metastasis and demonstrates HIPEC to be both effective and safe. Measurement of the tumor marker carcinoembryonic antigen has been shown to be an effective indicator of future outcomes in gastric cancer treated with CRS-HIPEC. Although the treatment outcomes have improved, even current treatment using CRS-HIPEC for gastric cancer with PC the survival rates can be dismal. Thus, the treatment of advanced gastric cancer with PC is an ongoing field of study and future directions of the treatment of gastric cancer with PC may include the use of intraperitoneal immunotherapy.

Impact of hyperthermic intraperitoneal chemotherapy on gastric cancer survival: Peritoneal metastasis and cytology perspectives

“…Our analysis suggested that CRS combined with HIPEC may enhance short-term survival in patients, with 2-year and 3-year survival rates of 28.70% and 9.60%, respectively. The median survival duration for individuals in the HIPEC cohort was 20.00 ± 4.89 months, consistent with the findings of Smith et al [ 11 ]. Liu’s et al meta-analysis of 21 randomized controlled trials, encompassing 1674 participants, demonstrated a significantly greater 3-year survival rate in patients receiving HIPEC than in those who did not[ 12 ].…”

Reply to Mazzei et al. Some Concerns from a Radiological Point of View. Comment on “Huang et al. Outcomes of Conversion Surgery for Metastatic Gastric Cancer Compared with In-Front Surgery plus Palliative Chemotherapy or In-Front Surgery Alone. J. Pers. Med. 2022, 12, 555”

“…Due to the drawbacks of noninvasive image modalities, diagnostic laparoscopy remains a useful method to clarify peritoneal carcinomatosis with the highest accuracy [ 7 , 8 ]. Furthermore, cytoreductive surgery (CC0 or CC1) plus hyperthermic intraperitoneal chemotherapy might offer an alternative to improve the overall survival for fit patients with a peritoneal cancer index score < 12 [ 9 ]. However, a large-scale randomized trial is needed to validate this approach.…”