Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: Results of the GYMSSA trial

Rudloff, Udo; Langan, Russell C.; Mullinax, John E.; Beane, Joal D.; Steinberg, Seth M.; Beresnev, Tatiana; Webb, Carole C.; Walker, Melissa; Toomey, Mary Ann; Schrump, David S.; Pandalai, Prakash K.; Stojadinovic, Alexander; Avital, Itzhak

doi:10.1002/jso.23633

Cited by 173 publications

(149 citation statements)

References 41 publications

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“…Morbidity ranged from 3.8% to 49% for gastrectomy and from 14% to 21% for non-resection surgeries 43 . In the literature update, procedure-related morbidity in moderatequality noncurative studies ranged from 15.1% 44 to 88.8% 45 for gastrectomy and from 11.5% 46 to 21% 47 for non-resection surgeries.…”

Section: Key Evidence For Recommendationmentioning

confidence: 99%

Staging and Surgical Approaches in Gastric Cancer: A Clinical Practice Guideline

et al. 2017

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Section: Key Evidence For Recommendationmentioning

confidence: 99%

Staging and Surgical Approaches in Gastric Cancer: A Clinical Practice Guideline

et al. 2017

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“…Initially, this regionally focused approach was built on the concept of maximizing drug delivery to the sites of tumor and metastases while simultaneously elongating the therapeutic window by reducing systemic toxicity. Indeed, in a large phase III clinical trial in colorectal cancer spread to the peritoneum, HIPEC and CRS extended median survival from 12.6 to 22.3 months (P=0.032) (17). Likewise, small trials have indicated an association with prolonged survival when applying this technique to AGC with PC (23)(24)(25).…”

Section: Crs + Hipec Clinical Experience: Promising Resultsmentioning

confidence: 98%

“…The combined application of hyperthermia and chemotherapy has a significant synergistic effect (17)(18)(19)(20)(21). Hyperthermia can eliminate and inhibit the ability of some oncogenes in the target cells to control cellular uptake and drug excretion, hence decreasing drug excretion while increasing the cumulative drug concentration.…”

Section: Thermodynamic Effect Can Significantly Enhance the Response mentioning

confidence: 99%

A critical analysis of the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy combo in the clinical management of advanced gastric cancer: an effective multimodality approach with scope for improvement

Beeharry

Yao

et al. 2016

Transl. Gastroenterol. Hepatol.

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Peritoneal carcinomatosis (PC) is manifested in up to 40% of gastric cancer (GC) patients, after which their 5-year survival drops to less than 5%. The currently most acceptable treatment option for advanced GC (AGC) is systemic chemo and radio therapies with however generally very unsatisfying results and this led to a resurgence of interest in regional therapies like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Small trials have indicated an association with prolonged survival when applying this technique to AGC manifesting with PC. High procedure-related morbidity and mortality associated with the CRS-HIPEC approach have however brought by a polemic on the merits of the latter: with the advent of regulatory approval of more effective as well as novel, more personalized treatment options in AGC, along with advances in tailoring investigational agents specifically for peritoneal delivery, there clearly is a need to outline the appropriate role of CRS-HIPEC in this disease.In a clear objective to improve the therapeutic efficiency of HIPEC, there have been immense developments in the technical aspects of this technology including the use of nanotechnology in more precise drug delivery systems (DDS) or choice of more efficient drugs such as gene-target technology, laparoscopy and so on. Henceforth, in this review, we will be highlighting the past and current status of the CRS + HIPEC procedure, shedding light on the pros and cons in order to boost up the efficiency of this multimodality approach.

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“…The joint experience of 15 Western centres with crs and hipec for ptc of gastric origin, comprising150 patients, revealed an overall median survival duration of 9.2 months and a 5-year survival rate of 13% 56 58 . To summarize, the survival of patients with ptc of gastric origin after crs and hipec, although improved, remains considerably poor.…”

Section: Gastric Cancermentioning

confidence: 99%

Treatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives

2016

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Peritoneal carcinomatosis (ptc) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although ptc is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (crs) and intraoperative hyperthermic intraperitoneal chemotherapy (hipec) has successfully been used as locoregional treatment for selected patients with ptc from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei. In the prophylactic setting, hipec can also be used to prevent ptc in high-risk patients, and the first results of the "second-look" approach are promising. Patient selection-in which the risks of perioperative morbidity and mortality, which are analogous to those for any other major gastrointestinal surgery, are assessed-is of utmost importance. Those risks have to be weighed against the anticipated survival benefit, which depends mainly on tumour biology, extent of disease, and probability of achieving complete crs. The present review discusses the principles of crs and hipec, the most significant recent clinical data, and current perspectives concerning the application of this treatment modality in various malignancies. Ongoing trials and future directions are noted. It appears that the combination of crs and hipec is an indispensable tool in the oncologist's armamentarium.

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Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: Results of the GYMSSA trial

Abstract: Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival.

Cited by 173 publications

References 41 publications

Staging and Surgical Approaches in Gastric Cancer: A Clinical Practice Guideline

Staging and Surgical Approaches in Gastric Cancer: A Clinical Practice Guideline

A critical analysis of the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy combo in the clinical management of advanced gastric cancer: an effective multimodality approach with scope for improvement

Treatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives

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