Modern approaches to the treatment of peritoneal carcinomatosis from gastric cancer (literature review)

Abstract

Background. Gastric cancer (GS ) is one of the most common and deadly cancers in Russia and worldwide. In 40 % of cases, GC is diagnosed at an advanced stage, thus increasing the risk of distant metastasis. Peritoneal carcinomatosis from GC is one of the most common pathways of dissemination, with a median survival time of less than 6 months.Aim. To study various modern approaches to the treatment of peritoneal carcinomatosis in gastric cancer.Material and Methods. Literature search was performed in Medline, Cochrane Library, Elibrary, Scopus, PubMed systems.Results. Currently, there is a wide variety of approaches to combined modality treatment of metastatic GC . Various options of cytoreductive surgeries are being developed. These surgeries are combined with neoadjuvant/adjuvant, intra-abdominal chemotherapy and radiation therapy. However, the results of studies on improving survival and reducing recurrence in patients with advanced GC are contradictory. Currently, patients with morphologically and cytologically confirmed free cancer cells in the peritoneal lavage without visualized intra-abdominal metastatic lesions are the most controversial group for the choice of appropriate treatment. Gastric cancer recurrence in these patients occurs within 2 years. In addition, the 5-year survival rate in patients with the presence of free cancer cells in peritoneal washings amounts for 2 %. One of the most effective experimental treatments for peritoneal carcinomatosis in gastric and ovarian cancers was intra-abdominal radionuclide therapy using colloidal198Au. The main advantage of the method was the complete cessation of the formation of effusion into the abdominal cavity in ascites forms of the disease. However, due to the high intestinal toxicity of radioactive gold tracer and radiation exposure to patients and medical staff, further work was stopped.Conclusion. Thus, the search of the most effective tactic of peritoneal carcinomatosis treatment in patients with advanced GC is still in progress.