Outcome Data of Patients with Peritoneal Carcinomatosis from Gastric Origin Treated by a Strategy of Bidirectional Chemotherapy Prior to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Single Specialized Center in Japan

Abstract

As a viable option, BIPSC with CRS and HIPEC for patients with PC arising from GC may be performed safely, with acceptable morbidity and mortality, in a specialized unit. Response to BIPSC, optimal CRS and limited peritoneal dissemination seem to be essential to achieve the best outcomes in these patients.

The Role of Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer

“…A multicentre European study reported that in patients who had a complete cytoreduction, the PCI score was the only independent factor predicting survival, with no patient surviving beyond 6 months and 3 years if PCI was >19 and >12 respectively [59]. In patients treated by bidirectional chemotherapy followed by CRS & HIPEC, a PCI of ≤6 was found to be an independent prognostic factor for survival (HR = 2.16 95 % CI = 1.17-3.98, p = 0.013) [66].…”

“…The response to neoadjuvant chemotherapy is another independent prognostic factor. After a NIPS protocol, a negative cytology has been shown to be associated with a better survival than a positive cytology (3 year survival 8.5 % vs 0 %) [65], and a major (grade 2/3) response has a better outcome than a lesser (HR = 2.6, 95 % CI = 1.17-3.98, p = 0.002) [66]. The other factors that have been found to predict a better survival after CRS & HIPEC include synchronous PM [57,60], systemic chemotherapy >6 cycles and no serious adverse events [60] and absence of signet ring cell histology [69] and absence of ascites [57].…”

“…Sequential therapy is repeated twice unless there is disease progression. Recently, an updated report of 194 patients treated with NIPS was published, of whom only 152 patients subsequently underwent CRS & HIPEC [66]. The morbidity and mortality were 26 % and 3.9 % respectively.…”

“…One of the most important factors associated with a good outcome following CRS & HIPEC for PM from gastric cancer is the completeness of cytoreduction [56][57][58][59]66]. A complete cytoreduction followed by HIPEC is associated with a median survival of 11 to 43 months and a 5-year survival of 17-30 % when compared to an incomplete cytoreduction (median survival 3.3-8.5 months and 5-year survival of 2 %) (see Table 3).…”

Preoperative Assessment of Cancer Patients with Peritoneal Metastases for Complete Cytoreduction

“…Verwaal et al published the prognostic score (PS); this assessment used five prognostic features that were each assigned a constant number. The lower the score, the better the response [24].…”