The role of HIPEC in the treatment of peritoneal carcinomatosis from gastric cancer

Abstract

Gastric cancer is one of the most dreadful neoplastic diseases and remains the second cause of cancer death worldwide. Patients who develop peritoneal metastasis have a poor prognosis, with a median survival of less than 6 months. Despite being the cause of 60% of deaths from gastric cancer, peritoneal metastasis can still be considered a local disease and a local multidisciplinary approach can improve the prognosis even in this end-stage disease. At present, hyperthermic intraperitoneal chemotherapy (HIPEC) is the most widely accepted treatment for peritoneal surface diseases and can be performed in patients with different stages of cancer and with various antitumoral drugs. We performed a systematic review of the current status of HIPEC in the treatment of gastric peritoneal metastasis in an attempt to obtain answers to the questions that still remain: do results differ with these different methods? Does HIPEC exert a significant effect on the intracavitary delivery of drugs? Which patients should be treated and which should not? What can we expect from this approach in terms of survival, morbidity, and mortality? On reviewing the literature, despite the lack of trials comparing the different methods, we found that HIPEC has been shown to be an effective tool whenever a complete or an almost complete resection of the peritoneal implants can be performed. Therefore, it is advisable to refer all at-risk patients to specialized centers to be enrolled in randomized trials to achieve truly reliable results.

Regional but fatal: Intraperitoneal metastasis in gastric cancer

“…At present, hyperthermic intraperitoneal chemotherapy (HIPEC) is the most widely accepted strategy among the treatment options for peritoneal dissemination which is the most frequent metastatic pattern in gastric cancer[28]. The theoretical advantage of the HIPEC is to add the direct cytotoxic effects of heat to a high local concentration of used cytostatic drug[29,30].…”

Feasibility of weekly intraperitoneal versus intravenous paclitaxel therapy delivered from the day of radical surgery for gastric cancer: a preliminary safety analysis of the INPACT study, a randomized controlled trial

“…Thus prevention of peritoneal metastasis is an important issue after the surgical treatment for gastric cancer worldwide. Methods to exterminate intraperitoneal cancer cells range from extensive intraoperative lavage with saline [24] to hyperthermic intraperitoneal chemotherapy (HIPEC) [9,25]. It is doubtful whether mere lavage could cure established metastatic foci on the peritoneum, whereas whether the expensive and potentially morbid HIPEC approach is of any added clinical value remains to be proven in a prospective randomized study.…”

“…To date, no comparison of intraperitoneal versus intravenous administration of PTX has been attempted for gastric cancer. Other treatment strategy involving intraperitoneal administration of anticancer drugs have either been unsuccessful [8] or technically demanding, with rather high morbidities and mortalities [9].…”

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].…”