Effect of neoadjuvant chemotherapy combined with hyperthermic intraperitoneal perfusion chemotherapy on advanced gastric cancer

Abstract

Neoadjuvant and hyperthermic intraperitoneal chemotherapies have been shown to be effective in the treatment of resectable advanced gastric cancer. The aim of the present study was to investigate the clinical efficiency and security of neoadjuvant chemotherapy in combination with hyperthermic intraperitoneal chemotherapy for the treatment of postoperative advanced gastric cancer. A total of 192 patients diagnosed with advanced gastric cancer were randomly divided into the following four groups (n=48 per group): Control, neoadjuvant chemotherapy, hyperthermic intraperitoneal perfusion chemotherapy and joint groups. The joint group received neoadjuvant chemotherapy combined with hyperthermic intraperitoneal perfusion chemotherapy. Complications, adverse reactions, recurrence rates within 2 years and the 1- and 3-year survival rates following surgery were observed. No significant differences were observed in the occurrence rates of I–II degree myelosuppression, III–IV degree myelosuppression, I–II degree nausea or III–IV degree nausea and vomiting among the four groups (P>0.05). The median progression-free survival times were 26, 31, 33 and 28 months in the control, neoadjuvant chemotherapy, hyperthermic intraperitoneal perfusion chemotherapy and joint groups, respectively (P<0.001). Compared with the control group, the recurrence-free 2-year survival rate of the joint group was significantly lower (P=0.04). The difference among the median survival times of the four groups was statistically significant (P=0.001). The 1-year survival rate of the joint group was significantly higher when compared with the control group and the difference was statistically significant (P=0.03). However, no statistically significant difference was identified among the 1-year survival rates of the four groups (P>0.05). Compared with the control group, the 3-year survival rates of the other three groups were significantly higher (P<0.05). Therefore, the results of the present study indicated that neoadjuvant chemotherapy combined with hyperthermic intraperitoneal perfusion chemotherapy for the treatment of advanced gastric cancer is well tolerated and exhibits improved compliance and efficiency.

The 30-year experience—A meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer

“…One RCT(19) reported a four arm subgroup analysis comprising the effect obtained in patients undergoing or not undergoing neoadjuvant chemotherapy. Two studies(13, 17) reported a third group in which patients underwent gastrectomy+NIC.…”

“…We did not analyze this group because it met the exclusion criteria for the meta-analysis. Eight studies(6, 14–16, 18, 26, 30) reported the use of Mitomycin C (MMC), eight studies(9, 16, 27, 30, 33, 42–44) a combination of MMC with cisplatin 8,12,18,23 or etoposide(25) or cisplatin+etoposide(24, 27, 29), one study(20) cisplatin alone, and another study(19) cisplatin combined with fluorouracil. The studies provided limited data regarding administration of neoadjuvant and adjuvant treatments.…”

“…Some considerations emerged though a deeper analysis of Cui’s RCT. (19) The study reported data from subgroups of patients who underwent or did not undergo a neoadjuvant therapy and its correlation with HIPEC administration. Comparing groups yielded a result strongly in favor of the use of neoadjuvant chemotherapy that appears independent from the use of HIPEC, as no statistical significance appeared in the comparison of the neoadjuvant+gastrectomy versus the neoadjuvant+gastrectomy+HIPEC group (P=0.19).…”

Optimization of perioperative approaches for advanced and late stages of gastric cancer: clinical proposal based on literature evidence, personal experience, and ongoing trials and research

“…In another trial from our institution (1998 to 2001), it was found that when comparing 42 subjects who underwent surgery + HIPEC with 54 subjects who had surgery alone, the 1-, 2-, and 4-year survival rates were more favorable in the HIPEC group, and the peritoneal recurrence was 34.7% vs. 10.3%, in favor of HIPEC [31]. In a study by Cui et al, where 192 AGC patients were randomly divided into the following four groups (control, NAC, HIPEC and combined groups), the results suggested that NAC combined with HIPEC for the treatment of AGC is well tolerated and exhibits improved compliance and efficiency [32]. In another study from our team, with a pool of 80 patients with 40 patients undergoing prophylactic HIPEC while the control group had surgery alone, the results showed that the experimental arm had significant survival benefit with a decrease in peritoneal metastatic rate [33].…”

Neoadjuvant Laparoscopic HIPEC combined with Neoadjuvant Chemotherapy followed by Surgery plus intraoperative HIPEC for Advanced Gastric Cancer at risk of Peritoneal Carcinomatosis: feasibility and safety assessment from retrospective case control study

“…With the optimization of the comprehensive treatment modality for AGC, the option of combining NAC's tumor down-staging and HIPEC's prophylactic against peritoneal dissemination was explored. In a study by Cui et al, the combination of NAC with HIPEC for the treatment of AGC was well tolerated and exhibited improved compliance and efficiency with survival benefit [18] . In a study by Coccolini et al, prophylactic HIPEC associated to NAC increased the DFS and OS in patients with AGC without carcinomatosis [19] .…”