Hyperthermic intraperitoneal chemotherapy (HIPEC) in combined treatment of locally advanced and intraperitonealy disseminated gastric cancer: A retrospective cooperative Central‐Eastern European study

Abstract

Background and Objectives Clinical experience in Western Europe suggests that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are promising methods in the management of gastric cancer (GC) with peritoneal metastases. However, there are almost no data on such treatment results in patient from Central‐Eastern European population. Methods A retrospective cooperative study was performed at 6 Central‐Eastern European HIPEC centers. HIPEC was used in 117 patients for the following indications: treatment of GC with limited overt peritoneal metastases (n = 70), adjuvant setting after radical gastrectomy (n = 37) and palliative approach for elimination of severe ascites without gastrectomy (n = 10). Results Postoperative morbidity and mortality rates were 29.1% and 5.1%, respectively. Median overall survival in the groups with therapeutic, adjuvant, and palliative indications was 12.6, 34, and 3.5 months. The only long‐term survivors occurred in the group with peritoneal cancer index (PCI) of 0‐6 points without survival difference in groups with PCI 7‐12 vs PCI 13 or more points. Conclusions GC patients with limited peritoneal metastases can benefit from CRS + HIPEC. Hyperthermic intraperitoneal chemotherapy could be an effective method of adjuvant treatment of GC with a high risk of intraperitoneal progression. No long‐term survival may be expected after palliative approach to HIPEC.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer with Synchronous Peritoneal Metastases: Multicenter Study of ‘Italian Peritoneal Surface Malignancies Oncoteam—S.I.C.O.’

“…5 Since its first description by Sugarbaker et al 6 and Yonemura et al 7 in the 1990s, CRS/HIPEC has progressively shown higher feasibility and efficacy from an oncological point of view. In recent years, similar encouraging results have been obtained by several other research groups, [8][9][10] particularly in selected groups of GC patients with oligometastatic peritoneal disease. However, although comprehensive treatment, consisting of CRS combined with HIPEC, seems to be the only strategy to improve the long-term survival of selected GC patients with synchronous PM, there is currently a lack of evidence regarding its clinical value.…”

Retrospective Cohort Study of Intraoperative Administration of Sustained-Release 5-Fluorouracil Implants in Advanced Gastric Cancer Patients

“…Although many methods have been developed to conquer the peritoneal metastasis, such as hyperthermic intraperitoneal chemotherapy (HIPEC) (Yarema et al, 2019), pressurized intraperitoneal erosol chemotherapy (PIPAC) (Sgarbura et al, 2019), the outcome of GC with peritoneal metastasis is still unsatisfied. Intraperitoneal (IP) infusion of chemotherapy drugs offers an attempt to expose cancer cells to anti-cancer drugs at high drug concentrations with minimal systemic toxic effects (Shinkai et al, 2018), but implantation of the port may cause some complications.…”

Treatment options for advanced gastric cancer with peritoneal metastasis: experience from a single institution in Korea

“…From scrutinizing patient selection and performing CRS with HIPEC only in group A, the outcome of our survival rate was higher compared to other studies [ 20 21 ]. It can be explained that localized PM with PCI scores below 13 was completely resected by CRS and micrometastasis was managed to be controlled to a certain extent by means of HIPEC followed by IP + systemic chemotherapy.…”