Neoadjuvant intraperitoneal chemotherapy followed by radical surgery and HIPEC in patients with very advanced gastric cancer and peritoneal metastases: report of an initial experience in a western single center

Fava, Bianca Escorel Costa; Costa, Wilson Luiz da; Medeiros, Maria Luiza Leite de; Sonagli, Marina; Ribeiro, Héber Salvador de Castro; Diniz, Alessandro Landskron; Godoy, A.; Farias, Igor Correia de; Jesus, Victor Hugo Fonseca de; Begnami, María Dirlei; Coimbra, Felipe J. F.

doi:10.1186/s12957-018-1363-0

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…The multidisciplinary treatment for resectable tumors, which today mainly includes a combination of chemotherapy and surgery, is one of the most promising strategies to deliver patients the benefit of different treatment modalities . So far, there are no trustworthy markers to evaluate the in vivo risk of metastatic disease or progression risk in this multidisciplinary scenario.…”

Section: Resultsmentioning

confidence: 99%

The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer

et al. 2019

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Background Gastric adenocarcinoma (GAC) is the third deadliest malignant neoplasm worldwide, mostly because of late disease diagnosis, low chemotherapy response rates, and an overall lack of tumor biology understanding. Therefore, tools for prognosis and prediction of treatment response are needed. Quantification of circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) and their expression of biomarkers has potential clinical relevance. Our aim was to evaluate CTCs and CTM and their expression of HER2 and plakoglobin in patients with nonmetastatic GAC, correlating the findings to clinicopathological data. Materials and Methods CTC enrichment was performed with isolation by size of epithelial tumor cells, and the analysis was performed with immunocytochemistry and microscopy. Two collections were made: one at diagnosis (55 samples before neoadjuvant treatment) and one after surgery and before adjuvant therapy (33 samples). Results A high detection rate of CTCs (90%) was observed at baseline. We evaluated HER2 expression in 45/55 biopsy samples and in 42/55 CTC samples, with an overlap of 36 subjects. Besides the good agreement observed for HER2 expression in primary tumors and paired CTCs for 36 cases (69.4%; κ = 0.272), the analysis of HER2 in CTCs showed higher positivity (43%) compared with primary tumors (11%); 3/5 patients with disease progression had HER2‐negative primary tumors but HER2‐positive CTCs. A significant CTC count drop in follow‐up was seen for CTC‐HER2‐positive cases (4.45 to 1.0 CTCs per mL) compared with CTC‐HER2‐negative cases (2.6 to 1.0 CTCs per mL). The same was observed for CTC‐plakoglobin‐positive cases (2.9 to 1.25 CTCs per mL). Conclusion CTC analysis, including their levels, plakoglobin, and HER2 expression, appears to be a promising tool in the understanding the biology and prognosis of GAC. Implications for Practice The analysis of circulating tumor cell levels from the blood of patients with gastric adenocarcinoma, before and after neoadjuvant treatment, is useful to better understand the behavior of the disease as well as the patients more likely to respond to treatment.

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Section: Resultsmentioning

confidence: 99%

The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer

et al. 2019

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“…In this regard, one might advocate that patients who received neoadjuvant treatment might actually benefit more from an ERAS regimen and it is therefore questionable whether these patients deserve to be excluded. Furthermore, neoadjuvant or perioperative chemotherapy is the standard of care prior to gastrectomy for cancer in many Asian and Western countries [56][57][58]. Lastly, as all studies included were from Asia, it may limit the application to Western populations.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery versus conventional care in gastric cancer surgery: a meta-analysis of randomized and non-randomized controlled trials

et al. 2019

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Introduction Enhanced recovery after surgery (ERAS) protocols have been successfully integrated into peri-operative management of different cancer surgeries such as colorectal cancer. Their value for gastric cancer surgery, however, remains uncertain. Methods A search for randomized and observational studies comparing ERAS versus conventional care in gastric cancer surgery was performed according to PRISMA guidelines. Random-effects meta-analyses with inverse variance weighting were conducted, and quality of included studies was assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa scale (PROSPERO: CRD42017080888). Results Twenty-three studies involving 2686 patients were included. ERAS was associated with reduced length of hospital stay (WMD-2.47 days, 95% CI − 3.06 to − 1.89, P < 0.00001), time to flatus (WMD-0.70 days, 95% CI − 1.02 to − 0.37, P < 0.0001), and hospitalization costs (WMD-USD$ 4400, 95% CI − USD$ 5580 to − USD$ 3210, P < 0.00001), with consistent results across open and laparoscopic surgery. Postoperative morbidity and 30-day mortality were similar, although a higher rate of readmission was observed in the ERAS group (RR = 1.95, 95% CI 1.03-3.67, P = 0.04). Patients in the ERAS arm had significantly attenuated C-reactive protein levels on days 3/4 and 7, interleukin-6 levels on days 1, and 3/4, and tumor necrosis factor-α levels on days 3/4 postoperatively. Conclusion Compared to conventional care, ERAS reduces hospital stay, costs, surgical stress response and time to return of gut function, without increasing post-operative morbidity in gastric cancer surgery. However, precaution is necessary to reduce the increased risk of hospital readmission when adopting ERAS.

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“…However, in their trial, Fujitani and colleagues did not consider the possibility of a complete surgical resection of both gastric cancer and metastases, limiting their comparison between chemotherapy alone versus gastrectomy plus chemotherapy in the metastatic setting. The recent literature [6][7][8][9][10][11][12][13][14][15] contrasts with the conclusion of the REGATTA Trial, showing that an integrated multidisciplinary approach including chemotherapy and surgery may offer, at least to a selected subgroup of patients, unexpected results, in particular when a radical (R0) resection can be achieved both on gastric primary and metastases. Although the power of these studies is limited by their retrospective nature, they cannot be ignored, particularly in the light of results achieved by conversion therapy.…”

Section: Introductionmentioning

confidence: 93%

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

Ministrini

Bencivenga

Solaini

et al. 2020

Cancers

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Background/Aim: This work explored the prognostic role of curative versus non-curative surgery, the prognostic value of the various localizations of metastatic disease, and the possibility of identifying patients to be submitted to aggressive therapies. Patients and Methods: Retrospective chart review of stage IV patients operated on in our institutions. Results: Two hundred and eighty-two patients were considered; 73.4% had a single metastatic presentation. In 117 cases, a curative (R0) resection of primary and metastases was possible; 75 received a R1 resection and 90 a palliative R2 gastrectomy. Surgery was integrated with chemotherapy in multiple forms: conversion therapy, HIPEC, neo-adjuvant and adjuvant treatment. Median overall survival (OS) of the entire cohort was 10.9 months, with 14 months for the R0 subgroup. There was no correlation between metastasis site and survival. At multivariate analysis, several variables associated with the lymphatic sphere showed prognostic value, as well as tumor histology and the curativity of the surgical procedure, with a worse prognosis associated with a low number of resected nodes, D1 lymphectomy, pN3, non-intestinal histology, and R+ surgery. Considering the subgroup of R0 patients, the variables pT, pN and D displayed an independent prognostic role with a cumulative effect, showing that patients with no more than 1 risk factor can reach a median survival of 33 months. Conclusions: Our data show that the possibility of effective care also exists for Western patients with stage IV gastric cancer.

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Neoadjuvant intraperitoneal chemotherapy followed by radical surgery and HIPEC in patients with very advanced gastric cancer and peritoneal metastases: report of an initial experience in a western single center

Cited by 12 publications

References 14 publications

The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer

The Potential Clinical Implications of Circulating Tumor Cells and Circulating Tumor Microemboli in Gastric Cancer

Enhanced recovery versus conventional care in gastric cancer surgery: a meta-analysis of randomized and non-randomized controlled trials

Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer

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