Efficacy of Regional Chemotherapy Approach in Peritoneal Metastatic Gastric Cancer

Abstract

Peritoneal spread is frequent in gastric cancer (GC) and a palliative condition. After failure to systemic chemotherapy (sCTx) remaining therapeutic options are very limited. We evaluated the feasibility and efficacy of locoregional chemotherapy (RegCTx) in peritoneal metastatic GC. In total, 38 (23 male and 15 female) patients with peritoneal metastatic GC after failure of previous sCTx and unresectable disease were enrolled in this study. Using the hypoxic abdominal stop-flow perfusion, upper abdominal perfusion and intraarterial infusion technique in total 114 cycles with Cisplatin, Adriamycin and Mitomycin C were applied. No significant procedure related toxicity was noticed- especially no Grade 3 or 4 toxicity occurred. With the RegCTx approach a median overall survival of 17.4 months was achieved. Patients who had undergone previously resection of the GC the median overall survival was even better with 23.5 months. RegCTx is a promising, safe and efficient approach in diffuse metastatic GC. The evaluation of RegCTx in the setting of multimodal treatment approach at less advanced stages is also warranted.

Regional Chemotherapy Is a Valuable Second-Line Approach in Metastatic Esophageal Cancer after Failure to First-Line Palliative Treatment

“…We have recently published our experience with the efficacy of RegCTx in metastatic gastric cancer [ 14 ]. Here we report on our experience with RegCTx approach in metastatic EC patients after failure to first-line treatment.…”

“…The reason for low toxicity profile with our RegCTx approach is based upon the frequent combination of RegCTx with chemo-filtration on the one hand but also using fewer total dosages and directed therapy towards a limited perfusion bed to reduce collateral damage to other organs hence also reducing the cumulative toxicity over time with ensuring a longer treatment phase if required [ 12 , 14 , 17 , 20 , 43 ].…”

“…The applied perfusion techniques have been described in detail previously [ 14 , 19 , 20 ]. To address the primary tumor, mediastinal, lung and cervical metastases an ITP was performed.…”

“…The regional chemotherapy (RegCTx) approach is an oncological approach with very low toxicity profile and high tumor response due to high cytotoxic drug concentrations in an isolated perfusion bed [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In addition, the therapy can be focused on limited regions if necessary, using the same technique (e.g., upper abdominal perfusion (UAP), isolated thoracic perfusion (ITP), and intra-arterial infusion (AI)).…”

“…The restricted perfusion bed that is treated during RegCTx allows potentiation of drug concentration levels at the tumor site compared to sCTx despite using up to 20–50% of lower overall cytotoxic drug amount. Furthermore, the possibility to perform a chemo-filtration ensures lowest systemic toxicity effects [ 12 , 14 , 15 , 16 , 19 ]. RegCTx efficacy has been proven in many cancers including metastatic gastric cancer but has not been reported in advanced metastatic EC.…”