Relation between Clinical and Histologic Outcome of Intraperitoneal Hyperthermic Perfusion for Patients with Gastric Cancer and Peritoneal Metastasis

Fujimoto, Shigeru; Takahashi, M; Kobayashi, K; Kure, Masanobu; Mutou, Takaaki; Masaoka, Hiroshi; Ohkubo, Harm

doi:10.1159/000227206

Cited by 45 publications

(23 citation statements)

References 2 publications

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“…The largest experience published so far was a retrospective French study involving 159 patients which confirmed this combination advantage in a selected CCR0 group of patients[35]. The dismal effect of HIPEC in patients with extensive peritoneal carcinomatosis not amenable to downstaging to CCR-0 may be explained by limited drug penetration leading to no anti-tumor effect on the deeply invasive microfoci[38]. Thus, drug delivery system with high permeability has the potential perspective role in the treatment of extensive peritoneal carcinomatosis cases[39].…”

Section: Effective Treatments For Patients With Peritoneal Metastasismentioning

confidence: 99%

Regional but fatal: Intraperitoneal metastasis in gastric cancer

Wei¹,

Wu²,

Liu³

2016

WJG

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Peritoneal carcinomatosis appears to be the most common pattern of metastasis or recurrence and is associated with poor prognosis in gastric cancer patients. Many efforts have been made to improve the survival in patients with peritoneal metastasis. Hyperthermic intraperitoneal chemotherapy remains a widely accepted strategy in the treatment of peritoneal dissemination. Several phase II-III studies confirmed that the combined cytoreducitve surgery and hyperthermic intraperitoneal chemotherapy resulted in longer survival in patients with peritoneal carcinomatosis. In addition, proper selection and effective regional treatment in patients with high risk of peritoneal recurrence after resection will further improve prognosis in local advanced gastric cancer patients.

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Section: Effective Treatments For Patients With Peritoneal Metastasismentioning

confidence: 99%

Regional but fatal: Intraperitoneal metastasis in gastric cancer

Wei¹,

Wu²,

Liu³

2016

WJG

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“…For that reason, various clinical attempts have been made to treat the peritoneal dissemination of gastric cancer, including systemic chemotherapy [2], intraperitoneal chemotherapy and/or hyperthermia [3], and aggressive surgery [4]. However, the results of these therapies have been unsatisfactory.…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneal administration of paclitaxel and oral S-1 for a patient with peritoneal dissemination and hydronephrosis due to advanced gastric cancer

et al. 2007

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S-1 has been developed in Japan as an oral anticancer drug, composed of tegafur, 5-chloro-2, 4-dihydroxypyridine (gimeracil), and monopotassium 1, 2, 3, 4-tetrahydro-2, 4-dioxo-1, 3, 5-triazine-6-carboxylate (oteracil), based on the biological modulation of 5-fl uorouracil (FU) [5]. Japanese late phase II trials of S-1 in gastric cancer have shown overall response rates of up to 49% and a median survival period of 8 months [6,7]. We have demonstrated that S-1 has a larger area under the curve 5-FU for peritoneal dissemination and ascites than for plasma [8], and thus S-1 might be effective for prolonging the survival of gastric cancer patients with peritoneal metastasis.Paclitaxel is a cytotoxic antineoplastic agent that results in tumor cell death by causing the excessive polymerization of tubulin and microtubule dysfunction [9]. The large molecular weight and bulky chemical structure of paclitaxel delay its peritoneal clearance [10] and increase exposure in the peritoneal cavity, and thus it can be exploited in the treatment of gastric cancer with peritoneal dissemination.We report a gastric cancer patient with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. Case reportA 34-year-old man was treated with an H2-blocker antagonist for about 6 months for a chief complaint of upper abdominal discomfort, suggesting the possibility of duodenal ulcer. Because his condition did not improve, he underwent endoscopic examination at another clinic. He was diagnosed as having type 3 advanced gastric cancer on the greater curvature of the gastric body by upper gastrointestinal (UGI) and endoscopic examination. He was referred to a hospital for surgical resection. An abdominal computed tomogra- AbstractWe report a patient with type 3 gastric cancer with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. He was diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m 2 was administered intraperitoneally on days 1 and 8, and S-1 at 100 mg/body was administered orally for 14 days, followed by 7 days' rest, as one course. After fi ve courses, primary tumor reduction was confi rmed and no cancer cells were detected on pathocytological investigation at second-look laparoscopy. The patient underwent total gastrectomy with lymph node dissection. He died from liver metastasis 29 months after the initial treatment, but he had not suffered from peritoneal metastases and had kept a good quality of life (QOL) since that treatment. This chemotherapy can be applied as one of the promising candidates for the treatment of patients with peritoneal metastasis of gastric cancer.

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“…The distance that drugs directly penetrate is only a few millimeters [18, 21], which can be interpreted to mean that there is no direct effect of drugs on any macroscopic residual tumors in the peritoneal cavity. For serosal invasion or peritoneal metastasis, several trials of combined IPT and hyperthermic perfusion have been conducted [24, 25, 26], and, at least in part, positive effects on patient survival have been reported. More recently, Crookes et al [27]achieved a median survival of over 4 years after combined preoperative systemic chemotherapy with postoperative IPT.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Intraperitoneal Chemotherapy with Mitomycin C, 5-Fluorouracil and Cisplatin for Advanced Gastric Cancer

Noh¹,

Yoo

Chung

et al. 2000

Oncology

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Objective: The long-term survival of patients who undergo surgery for stage IV gastric cancer is poor, due to metastatic spread of the tumor. Intraperitoneal chemotherapy (IPT) as a possible treatment for peritoneal dissemination has been investigated in a number of different tumors. The aim of this study was to investigate the toxicity and impact of early postoperative IPT on the survival of patients with advanced gastric cancer. Methods: Between 1993 and 1997, a total of 91 patients with stage IV gastric cancer who underwent potentially curative or palliative resection received intraperitoneal mitomycin C before closure of the abdominal wound. 5-Fluorouracil and cisplatin were administered intraperitoneally on postoperative days 1–4, and this was repeated at 4-week intervals. Results: All patients received a median of 3 IPT perfusions. There were 24 (26.4%) postoperative complications and 1 (1.1%) mortality. The most frequent hematologic toxicity (grade 3–4) was leukopenia. The major nonhematologic toxicities (grade 3–4) were emesis and nephrotoxicity. After a median follow-up period of 26 months, 14 patients remain alive without evidence of recurrence, whereas 75 patients died due to recurrence or progression of disease. The median survival period for all 91 patients was 15.4 months. When survival according to the residual tumor was analyzed, median survival was 36.0 months in the R0 (curative resection) group, 20.6 months in the R1 group (margins of resected specimens showing microscopic residual tumor or diameter of each residual tumor less than 3 mm) and 9.0 months in the R2 group (macroscopic residual tumor larger than 3 mm) (p < 0.001). Conclusions: IPT was found to be safe, and it appears to improve the prognosis in patients with minimal residual tumors. However, complete cytoreductive surgery is mandatory for achieving the beneficial effect of IPT.

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Relation between Clinical and Histologic Outcome of Intraperitoneal Hyperthermic Perfusion for Patients with Gastric Cancer and Peritoneal Metastasis

Cited by 45 publications

References 2 publications

Regional but fatal: Intraperitoneal metastasis in gastric cancer

Regional but fatal: Intraperitoneal metastasis in gastric cancer

Intraperitoneal administration of paclitaxel and oral S-1 for a patient with peritoneal dissemination and hydronephrosis due to advanced gastric cancer

Early Postoperative Intraperitoneal Chemotherapy with Mitomycin C, 5-Fluorouracil and Cisplatin for Advanced Gastric Cancer

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