Gastric cancer with peritoneal metastases: Efficiency of standard treatment methods

Yarema, Roman; Оhorchak, Мyron; Hyrya, Petro; Kovalchuk, Yuriy; Safiyan, Victor; Ferneza, Severyn; Fetsych, Markiyan; Matusyak, Myron; Oliynyk, Yuriy; Fetsych, Тaras

doi:10.4251/wjgo.v12.i5.569

Cited by 28 publications

(22 citation statements)

References 23 publications

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“…Peritoneal metastasis (PM) occurs in up to 60% of advanced or recurrent diseases of solid tumors (Heintz et al., 2006 ; Quere et al., 2015 ; Yarema et al., 2020 ), which leads to a poor expected median survival of fewer than 20 months despite various types of intravenous chemotherapy (Robella et al., 2016 ). Specifically, intravenous chemotherapy shows little effect on improving the prognosis of patients with PM because of the insufficient blood supply to the peritoneal surface with low penetration into tumors, thereby preventing eradication (Thadi et al., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Development of rotational intraperitoneal pressurized aerosol chemotherapy to enhance drug delivery into the peritoneum

Park

Lee

et al. 2021

Drug Delivery

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This study aims to evaluate the drug distribution, tissue concentrations, penetration depth, pharmacokinetic properties, and toxicities after rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) in pigs. Because relevant medical devices have not been introduced, we developed our prototype of pressurized intraperitoneal aerosol chemotherapy (PIPAC) and RIPAC by adding a conical pendulum motion device for rotating the nozzle. RIPAC and PIPAC were conducted using 150 ml of 1% methylene blue to evaluate the drug distribution and 3.5 mg of doxorubicin in 50 ml of 0.9% NaCl to evaluate the tissue concentrations and penetration depth, pharmacokinetic properties, and toxicities. All agents were sprayed as aerosols via the nozzle, DreamPen ® (Dalim Biotech, Gangwon, South Korea), with a velocity of 5 km/h at a flow rate of 30 ml/min under a pressure of 7 bars, and capnoperitoneum of 12 mmHg was maintained for 30 min. As a result, RIPAC showed a wider distribution and stronger intensity than PIPAC. Compared with PIPAC, RIPAC demonstrated high values of the tissue concentration in the central, right upper, epigastrium, left upper, left lower, right lower, and right flank regions (median, 375.5–2124.9 vs. 161.7–1240 ng/ml; p ≤ .05), and higher values of the depth of concentrated diffusion and depth of maximal diffusion (median, 232.5–392.7 vs. 116.9–240.1 μm; 291.2–551.2 vs. 250.5–362.4 μm; p ≤ .05) in all regions except for bowels. In RIPAC, the pharmacokinetic properties reflected hemodynamic changes during capnoperitoneum, and there were no related toxicities. Conclusively, RIPAC may have the potential to enhance drug delivery into the peritoneum compared to PIPAC.

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Section: Introductionmentioning

confidence: 99%

Development of rotational intraperitoneal pressurized aerosol chemotherapy to enhance drug delivery into the peritoneum

Park

Lee

et al. 2021

Drug Delivery

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“…The results showed no differences in creatinine, bilirubin, ALP, AST, ALT, GGT, or CRP before RIPAC, immediately after RIPAC, or on days 1, 2, 3, or 4. 50 (38,64,3) 83 (31,98) 95 (36,122) 69 (20,154) 86 (21, 97.1) 83 (38, 92.8) 0.978 ALT (IU/l) 37 (24,55) 37 (23,54) 38 (24,38) 45 (22,50) 51 (21,55) 50 (21,68) 63 (20,64) 0.982 GGT (IU/l) 59 (21,76) 49 (22,63) 53 (26,56) 48 (27,59) 54 (25,56) 51 (24,64) 55 ( All values were shown as median with range Discussion PIPAC has been suggested to be useful as palliative therapy for PM of recurrent or refractory solid tumors, which may lead to histologic regression, and thereby improve the quality of life [22][23][24][25]. Even if chemotherapeutic agents shown to be resistant in intravenous chemotherapy are used again in PIPAC, the agents may be absorbed into the peritoneal tumors by passive diffusion, which can be effective for treating PM by maintaining higher concentrations within tumor tissues while minimizing systemic absorption [26,27].…”

Section: Pharmacokinetics Of Ripac Using Doxorubicinmentioning

confidence: 99%

“…Peritoneal metastasis (PM) occurs in up to 60% of advanced or recurrent diseases of solid tumors [1][2][3], which leads to a poor expected median survival of fewer than 20 months despite various types of intravenous chemotherapy [4]. Speci cally, intravenous chemotherapy shows little effect on improving the prognosis of patients with PM because of the poor blood supply to the peritoneal surface with low penetration into tumors, thereby preventing eradication [5].…”

mentioning

confidence: 99%

Development of Rotational Intraperitoneal Pressurized Aerosol Chemotherapy to Enhance Drug Delivery into the Peritoneum

Park

Lee

et al. 2021

Preprint

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Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced as palliative therapy for treating peritoneal metastasis (PM) of solid tumors. However, restricted use in the limited countries and the uneven distribution and penetration in various regions of the peritoneal cavity ac as disadvantages of PIPAC. Thus, the KOrean Rotational Intraperitoneal pressurized Aerosol chemotherapy (KORIA) trial group developed rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) for enhancing drug delivery into the peritoneum to treat PM, and evaluated the drug distribution, tissue concentrations, penetration depth, pharmacokinetic properties, and toxicities after RIPAC with doxorubicin in pigs. Methods For delivering doxorubicin as aerosols, we used our prototype for PIPAC, which sprayed about 30-µm sized droplets through the nozzle. The mean diameter of the sprayed region was 18.5 cm, and the penetration depth ranged from 360 to 520 µm, comparable to the microinjection pump (Capnopen®; Capnomed, Villingendorf, Germany). For RIPAC, a conical pendulum motion device was added to PIPAC for rotating the nozzle. RIPAC and PIPAC were conducted using 150 ml of 1% methylene blue to evaluate drug distribution and 3.5 mg of doxorubicin in 50 ml of 0.9% NaCl to evaluate tissue concentration and penetration depth, pharmacokinetic properties, and toxicities. All agents were sprayed as aerosols via the nozzle with a velocity of 5 km/h at a flow rate of 30 ml/min under a pressure of 7 bars, and capnoperitoneum of 12 mmHg was maintained for 30 minutes. As a control, we conducted early postoperative intraperitoneal chemotherapy (EPIC) using 1% methylene blue solution with an infusion flow rate of 100 ml/min for 30 minutes and the drainage of 1 L every 10 minutes. Results RIPAC showed a wider distribution and stronger intensity than EPIC and PIPAC. Moreover, the tissue concentration and penetration depth of doxorubicin were higher in RIPAC than in PIPAC. In RIPAC, the pharmacokinetic properties reflected hemodynamic changes during capnoperitoneum, and there were no renal and hepatic toxicities related to RIPAC using doxorubicin. Conclusions RIPAC may have the potential to enhance drug delivery into the peritoneum compared to PIPAC.

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“…Palliative systemic chemotherapy has remained the only acceptable specific treatment. The median survival of patients with PC treated with the best supportive care usually does not exceed 3–14 months, depending on the origin of the primary tumour [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of the enhanced recovery after surgery protocol for patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion

Tkachenko¹,

Chetverikov²,

Bondar³

et al. 2021

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Aim of the study To investigate the feasibility of enhanced recovery after surgery (ERAS) protocol for patients with primary peritoneal carcinomatosis (PC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC) based on the length of hospital stay (LOS), return of bowel function, the incidence of postoperative complications, and quality of life (QLQ) analysis. Material and methods The study included a total of 37 patients with primary PC of different origin, who underwent cytoreductive surgery plus HIPEC. Patients were divided into 2 groups: Group I (nonERAS) – 20 patients and Group II (ERAS) – 17 patients. Results The median LOS in Group I (nonERAS) (12.35 ± 3.9) was longer than in Group II (ERAS) (6.8 ± 1.9) ( p < 0.01). The use of the ERAS protocol significantly contributed to the faster return of bowel function (peristalsis and stool) in the postoperative period ( p < 0.01). There was no statistically significant difference in the incidence of postoperative complications between the ERAS and nonERAS groups, which supports its clinical safety. Improved QLQ according to the obtained data has also been achieved due to the introduction of the principles of the ERAS protocol. Conclusions The obtained results prove the expediency and feasibility of the implementation of the ERAS protocol among patients undergoing cytoreductive surgery in combination with HIPEC.

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Gastric cancer with peritoneal metastases: Efficiency of standard treatment methods

Cited by 28 publications

References 23 publications

Development of rotational intraperitoneal pressurized aerosol chemotherapy to enhance drug delivery into the peritoneum

Development of rotational intraperitoneal pressurized aerosol chemotherapy to enhance drug delivery into the peritoneum

Development of Rotational Intraperitoneal Pressurized Aerosol Chemotherapy to Enhance Drug Delivery into the Peritoneum

Implementation of the enhanced recovery after surgery protocol for patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion

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