A retrospective analysis of hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis

Abstract

Abstract. Peritoneal metastasis (PM) is a poor prognostic factor in patients with gastric cancer. The aim of this study was to evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced gastric cancer with PM by retrospective analysis. A total of 54 gastric cancer patients with positive ascitic fluid cytology were included in this study: 23 patients were treated with systemic chemotherapy combined with HIPEC (HIPEC+ group) and 31 received systemic chemotherapy alone (HIPEC-group). The patients were divided into 4 categories according to the changes of ascites, namely disappear, decrease, stable and increase. The disappear + decrease rate in the HIPEC+ group was 82.60%, which was statistically significantly superior to that of the HIPEC-group (54.80%). The disappear + decrease + stable rate was 95.70% in the HIPEC+ group and 74.20% in the HIPEC-group, but the difference was not statistically significant. In 33 patients with complete survival data, including 12 from the HIPEC+ and 21 from the HIPEC-group, the median progression-free survival was 164 and 129 days, respectively, and the median overall survival (OS) was 494 and 223 days, respectively. In patients with ascites disappear/decrease/stable, the OS appeared to be better compared with that in patients with ascites increase, but the difference was not statistically significant. Further analysis revealed that patients with controlled disease (complete response + partial response + stable disease) may have a better OS compared with patients with progressive disease, with a statistically significant difference. The toxicities were well tolerated in both groups. Therefore, HIPEC was found to improve survival in advanced gastric cancer patients with PM, but the difference was not statistically significant, which may be attributed to the small number of cases. Further studies with larger samples are required to confirm our data.

Response of OVCAR-3 Cells to Cisplatin and Hyperthermia: Does Hyperthermia Really Matter?

“…HIPEC, combining regional hyperthermia and IPC after CRS, has been applied to treat PC and is the most effective and recommended treatment option for appendiceal mucinous cancer and pseudomyxoma peritonei (20). For a number of malignancies that present with PC, including peritoneal mesothelioma (21), and gastric (22), colorectal (23) and pancreatic (24) cancer, CRS and HIPEC prolonged long-term survival in selected patients. Some oncology centres, encouraged by the promising results of HIPEC in the treatment of PC of gastrointestinal origin, have shifted this method as a treatment option to patients with advanced EOC (25).…”

Integrated miRNA profiling and bioinformatics analyses reveal upregulated miRNAs in gastric cancer

“…A significant challenge for GC treatment is the absence of early diagnostic biomarkers (6). Yuan et al (7), reported that the 5-year survival rate of early GC is ~30-fold high compared with that of late-stage GC. A number of studies have identified aberrantly expressed miRNAs in GC, which serve regulatory roles in tumors (8).…”

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

“…The HIPEC population had decreased gastric cancer-related symptoms than those receiving chemotherapy alone, particularly the presence of malignant ascites was reduced. 16 Similarly, in studies by Facchiano et al, 65 and Yarema et al, 25 they showed that, as well as providing survival benefit associated with CRS-HIPEC, HIPEC alone caused complete clinical regression of the symptoms of malignant ascites in patients with primary gastric cancer with PC. Remarkably, evidence for palliation of malignant ascites via HIPEC had already been described by the late 1990s.…”

“…In a retrospective study, Yuan et al 16 showed that, when compared with traditional chemotherapy, HIPEC increases both survival and improves quality of life. The HIPEC population had decreased gastric cancer-related symptoms than those receiving chemotherapy alone, particularly the presence of malignant ascites was reduced.…”

“…[16][17][18] A retrospective study by Yuan et al, 16 showed a 1-year survival rate of 41.7% in patients receiving HIPEC and a corresponding 1-year survival of 23.8% for the systemic chemotherapy group. Rudloff et al, 17 also did a retrospective study on patients treated with multimodal therapy (CRS, HIPEC, and systemic chemotherapy) vs patients treated with systemic chemotherapy alone and showed the median overall survival to be 11.3 months in the multimodal treatment group compared with 4.3 months in the traditional chemotherapy group.…”