Multicenter Retrospective Analysis of Intraperitoneal Paclitaxel and Systemic Chemotherapy for Advanced Gastric Cancer with Peritoneal Metastasis

Abstract

Purpose:The objective of the present retrospective analysis was to describe the experience of intraperitoneal (IP) paclitaxel and systemic chemotherapy in patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC) in a multicenter setting in Korea. Materials and Methods: The medical records of patients with AGC, who were diagnosed with PM between January 2015 and December 2018, were reviewed. IP catheter was placed in the pouch of Douglas and was used for the administration of IP paclitaxel chemotherapy. Results: We reviewed the clinical outcomes of IP paclitaxel and systemic chemotherapy administration in 82 patients at six institutions in Korea. Mean number of IP chemotherapy cycles was 6.6. The mean peritoneal cancer index (PCI) was 21.9. Postoperative complications related to IP catheter and port were observed in 15 patients. The overall median survival was 20.0 months. A significant difference was observed in the survival rate according to the ascites grade (grade I and II, 24.1 months; grade III and IV, 15.3 months; P=0.014) and PCI grade (grade I, 25.6 months; grade II and III, 16.3 months; P=0.023). Conclusions:The feasibility of IP paclitaxel and systemic chemotherapy administration was demonstrated in this experience-based retrospective analysis suggesting that the procedure is beneficial in patients with PM of AGC.

Efficacy of AS versus SOX regimen as first-line chemotherapy for gastric cancer patients with peritoneal metastasis: a real-world study

“…The ABSOLUTE trial showed the weekly ABX regimen had longer OS than the paclitaxel regimen (9.9 vs. 8.7 months) of peritoneal metastasis in gastric cancer patients [ 13 , 32 ]. Recently, the combination of intraperitoneal paclitaxel and systemic chemotherapy in advanced gastric cancer patients with peritoneal metastasis could enhance the OS to 20.0 months [ 33 ]. ABX following intravenous administration was thought to be infiltrated into the peritoneal tumor to the same degree as intraperitoneal injection [ 34 ].…”

Intraperitoneal Paclitaxel Combined with S-1 Plus Oxaliplatin for Advanced Gastric Cancer with Peritoneal Metastasis: a Phase I Study

“…We previously reported significant complications associated with an implanted access port and catheter system (18.3%) in a multicenter retrospective study [ 12 ]. Among these complications, abscess and infection can be fatal.…”

“…To overcome the limitations of previous studies, the perioperative IP and systemic chemotherapy for gastric cancer (PIPS-GC) study group was established in 2017 to manage AGC with PM in Korea. A multicenter retrospective study on IP chemotherapy has been performed, which showed satisfactory results [ 12 ]. Based on these results, we planned to conduct a phase I/II clinical trial.…”

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

“…Given that all visible tumors had to be removed to achieve complete cytoreduction, concomitant resection of visceral organs was inevitable, resulting in several serious complications. After joining the PIPS-GC study group, we discussed treatment options with other institutional researchers for patients of PM [ 19 ] and ultimately accepted the approach of patient selection based on the PCI score and patients' potential for complete cytoreduction after reflecting on the discussions. We established 2 treatment strategies based on PCI score with a cutoff value of 13 points ( Fig.…”