Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

Abstract

Background: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer. Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer. Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer with Synchronous Peritoneal Metastases: Multicenter Study of ‘Italian Peritoneal Surface Malignancies Oncoteam—S.I.C.O.’

“…Accordingly, our survival analysis is in line with these findings. However, completeness of cytoreduction was found to be a prognostic factor in several other studies, 3,8,20,37 suggesting CCS-0 as mandatory before a HIPEC procedure.…”

“…3,7,11,20,[31][32][33][34][35][36] Peritoneal Cancer Index It is well-established that the lower the quantitative expression of tumor burden, expressed as PCI, the greater the chance to obtain complete CRS. 37 However, if on the one hand the role of PCI as a prognostic factor is clear, on the other hand the cut-off for favorable prognosis is still debated. 3,11,20,30,38 French and Japanese groups support a cut-off level of B 6 or 7 according to their retrospective series, 11,39 even if a cut-off of 12 does not seem unreasonable.…”

“…3,11,20,30,38 French and Japanese groups support a cut-off level of B 6 or 7 according to their retrospective series, 11,39 even if a cut-off of 12 does not seem unreasonable. 10,11,40 In 81 patients with GC and PC from five French institutions treated with complete CRS and HIPEC, Chia et al 37 reported a median OS for patients with PCI \ 7 of 26.4 months versus 10.9 months for patients with PCI C 7. This same PCI cut-off also proved Overall complications are reported according to the Clavien-Dindo classification for grading complications significantly prognostic for survival in the study by Yonemura 41 (median OS of 33 months for PCI \ 7 vs. 13 months for higher PCI scores), and, more recently, in a multicenter study of Spanish Group of Peritoneal Oncologic Surgery (patients with PCI B 6 had a median OS of 26.1 months vs. 18.1 months for patients with PCI [ 6).…”

Cytoreductive surgery (CRS) with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) versus standard of care (SoC) in people with peritoneal metastases from colorectal, ovarian or gastric origin: protocol for a systematic review and individual participant data (IPD) meta-analyses of effectiveness and cost-effectiveness

“…There have been several overviews, systematic reviews, and health technology assessments (HTA) investigating this area. Sixteen systematic reviews of comparative studies have been undertaken, comparing CRS+HIPEC to other treatment modalities in peritoneal metastases from colorectal, ovarian, or gastric cancer [6,17,20,[29][30][31][32][33][34][35][36][37][38][39][40][41]. Ten of these included at least one RCT, but the conclusions were largely based on non-randomised studies [6, 17, 20, 29, 31-33, 35, 39, 41].…”

The Role of CAR-T Cells in Peritoneal Carcinomatosis from Gastric Cancer: Rationale, Experimental Work, and Clinical Applications

“…The peritoneum is a common site of metastasis, and peritoneal metastases are associated with low rates of patient survival [4]. Following complete cytoreduction, the 5-year overall survival rate in patients with gastric peritoneal carcinomatosis (PC) is 13% to 23% [5]. Half of the patients with GC will develop PC, and PC will be present in up to 20% of patients with a potential resectable tumor.…”