Hyperthermic intraperitoneal perfusion chemotherapy and response evaluation in patients with gastric cancer and malignant ascites

Abstract

Abstract. The present study describes the use of bidirectional chemotherapy in the treatment of patients with gastric cancer and peritoneal carcinomatosis (PC), using newly developed response criteria for the treatment of malignant ascites. In addition, the association between effusion response and survival was analyzed. Between June 2010 and May 2014, patients affected by malignant ascites secondary to unresectable PC of gastric origin were treated with a combination of systemic and loco-regional chemotherapy. Cisplatin (75 mg/m 2 ) at an inflow temperature of 43˚C was infused intraperitoneally, and docetaxel (75 mg/m 2 ) was infused simultaneously via a peripheral vein, on day 1 every 3 weeks. The primary endpoint was overall survival rate, and the secondary endpoint was efficacy against malignant ascites using new response criteria. In total, 41 patients were enrolled, the majority of whom received 6 cycles of intraperitoneal chemotherapy in combination with hyperthermia. The majority of patients exhibited clinical regression of ascites and relief of associated symptoms. Malignant ascites disappeared [complete response (CR)] or decreased by 50% [partial response (PR)] in 73.2% of patients. No mortalities associated with the procedures occurred. The median survival time was 8.6 months, and the 1-year survival rate was 24.4%. As these new response criteria for the treatment of malignant ascites were found to be feasible, bidirectional chemotherapy may be the preferred strategy for the treatment of gastric cancer with PC. The CR, PR and non-PR groups showed significant differences in overall survival, indicating that decreased effusion was associated with improved patient survival.

Cytoreductive surgery and HIPEC for malignant ascites from colorectal cancer - a randomized study

“…Studies have shown that HIPEC has good clinical efficacy in controlling ascites for patients with malignant ascites originating from peritoneal carcinomatosis. [ 2 , 13 , 14 ] In the present study, CRS+HIPEC and HIPEC+dCRS demonstrated a rather good efficacy in reducing malignant ascites and alleviating related symptoms. The total ascites objective remission rate was 100%, even though a complete CRS was not achieved in any patient in the present study.…”

“…Studies showed that many primary or secondary intraperitoneal tumors such as gastric cancer, ovarian cancer, breast cancer, pseudomyxoma peritonei, or gastrointestinal stromal tumor could present a large amount of malignant ascites. [ 2 – 11 ] In the present study, CRC patients with malignant ascites included various pathological types such as well-differentiated adenocarcinoma, moderately differentiated adenocarcinoma, poorly differentiated adenocarcinoma, and mucinous adenocarcinoma or signet ring cell carcinoma. The results showed that there were no definite relationships between the formation of malignant ascites, tumor sites, and pathological types.…”

“…[ 1 , 12 – 14 ] A modest increase in life expectancy of up to 2 to 3 months has been observed with modern chemotherapy, depending upon the primary disease. [ 2 – 4 , 12 , 13 ] Symptomatic treatments with paracentesis improve distension and dyspnea, but the effects are short-lived as the ascites quickly accumulate, and cognitive and emotional quality of life continues to decline. [ 2 – 4 , 14 ] Targeted therapy using catumaxomab only prolongs puncture-free survival and delays the deterioration in the quality of life.…”

“…[ 2 – 4 , 12 , 13 ] Symptomatic treatments with paracentesis improve distension and dyspnea, but the effects are short-lived as the ascites quickly accumulate, and cognitive and emotional quality of life continues to decline. [ 2 – 4 , 14 ] Targeted therapy using catumaxomab only prolongs puncture-free survival and delays the deterioration in the quality of life. [ 10 , 11 ] Pressurized intraperitoneal aerosol chemotherapy [ 10 , 11 ] is not suitable for patients with peritoneal carcinomatosis and malignant ascites complicated with intestinal obstruction induced by tumor or with digestive duct hemorrhage.…”

Gold nanorods together with HSP inhibitor-VER-155008 micelles for colon cancer mild-temperature photothermal therapy

“…We believe that the graphene @VER-M or nano Fe 3 O 4 @VER-M system would be useful for mild PTT in the future. Or more succinctly, other kinds of heat treatments for cancer therapy such as hot compress 80 and hyperthermic perfusion 81 could be enhanced by forming hot compress@VER-M or hyperthermic perfusion@VER-M system.…”