Hyperthermic Intraperitoneal Chemotherapy in the Management of Gastric Cancer: A Narrative Review

Abstract

Gastric cancer (GC) patients with peritoneal metastasis tend to achieve poor clinical outcomes. Until recently, the treatment options were limited mainly to either palliative chemotherapy or radiation therapy in exceptional cases. Currently, these patients benefit from multimodal treatment, such as cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Despite good overall results, this treatment modality is still widely debated. The following study is designed to assess the papers about the possible application and utility of HIPEC in GC. A search in the PubMed, Web of Science, and Scopus databases was performed to assess the papers devoted to the role of HIPEC in GC treatment; a literature search was performed until March 21st; and, finally, 50 studies with a total number of 3946 patients were analyzed. According to the most recent data, it seems to be reasonable to limit the duration of HIPEC to the shortest effective time. Moreover, the drugs used in HIPEC need to have equal concentrations and the same solvent. Perioperative chemotherapy needs to be reported in detail and, furthermore, the term “morbidity” should be defined more clearly by the authors.

Treatment options in synchronous peritoneal metastasis from gastric cancer: A retrospective cohort analysis

“…Cytoreductive surgery is the essential component of curative treatment of PSM and aims to resect macroscopically visible tumour implants within the peritoneal cavity. Peritoneal metastases are relatively common in advanced stage gastric cancer and these patients have a poor prognosis despite systemic chemotherapy [7,8].…”

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

“…The poor prognosis after standard chemotherapy and the attitude of that remaining, confined to the abdomen, has produced an increased interest in the use of IP therapy. IP chemotherapy takes advantage of the blood–peritoneal barrier to achieve a much higher drug concentration at the peritoneal surface [ 107 , 108 , 109 , 110 ]. The addition of hyperthermia to IP chemotherapy implies the thermal enhancement of the chemotherapeutic agents used, increased drug uptake in malignant cells secondary to increased membrane permeability, inhibits repair mechanisms, facilitates lysosomal enzyme activation and selectively improves vascular flow in normal cells [ 18 , 111 , 112 ].…”