The Role of Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer

Abstract

Peritoneal metastasis, either synchronous or metachronous, is commonly seen in gastric cancer. It is associated with a poor prognosis, with a median survival of less than one year. The outcomes are not significantly improved by the use of systemic chemotherapy. We review the relevant literature on the role of HIPEC in gastric cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in three situations in gastric cancer. Besides its role as a definitive treatment in patients with established peritoneal metastasis (PM), it has been used as a prophylaxis against peritoneal recurrence after curative surgery and also as a palliative treatment in advanced peritoneal metastasis with intractable ascites. While prophylactic HIPEC has been shown to reduce peritoneal recurrence and improve survival in many randomised trials, palliative HIPEC can reduce the need for frequent paracentesis. Although CRS with HIPEC has shown promise in increasing the survival of selected patients with established PM from gastric cancer, larger studies are needed before this can be accepted as a standard of care.

Overall and disease-free survival in patients treated with CRS + HIPEC with cisplatin and paclitaxel for gastric cancer with peritoneal carcinomatosis

“…The most attractive use of HIPEC in GC would be in an adjuvant setting after a curative surgical resection in patients with a high risk of peritoneal recurrence (prophylactic HIPEC). Randomized trials and meta-analysis were performed to study the results of prophylactic HIPEC in patients with locally advanced GC and reported that HIPEC was associated with a significant improvement in the survival rate and in peritoneal recurrence (1,6,8,(11)(12)(13).…”

“…The median survival for patients with peritoneal carcinomatosis (PC) caused by GC is only between 3 to 7 months, while the median survival increases up to 9.5−12 months in patients with PC, caused by GC, who underwent chemotherapy (1). The management of locally advanced GC (perioperative chemotherapy followed by gastrectomy and D2 lymphadenectomy) is based on solid clinical evidence (2).…”

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

“…7 While there is a significant body of evidence supporting the use of HIPEC with surgery to improve the mortality of patients with advanced gastric cancer, some authors have noted that larger studies with more data are needed to definitively establish these techniques as the standard of care. 26,29,51,52 Regardless, the evidence is strong enough to support CRS with HIPEC as the recommended treatment for gastric cancer with peritoneal metastases. 7 In fact, in 2016 China defined this therapy as the standard treatment for advanced gastric cancer.…”

Peritoneal Carcinomatosis of Gastric Origin – Treatment Possibilities

“…Na druhou stranu pe ritoneální karcinomatóza se objevuje u 3-50 % nemocných s recidivou po ku rativní léčbě a 60 % nemocných s karci nomem žaludku má v době úmrtí meta statický rozsev po peritoneální dutině. Riziko postižení peritonea (jak při pri mární dia gnostice, tak ve smyslu reci divy) stoupá se zvyšujícím se T a N sta diem [3]. Lze odhadnout, že v ČR se karcinomatóza peritonea při tumoru ža ludku objeví u cca 200-800 nemocných za rok.…”

“…Z dosud publikovaných studií a meta analýz lze předpokládat až 50% redukci intraperitoneální rekurence u karci nomu žaludku při profylaktickém použití HIPEC. Tyto výsledky jsou spojené s del ším přežitím oproti standardně léčené skupině [3].…”