Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer

Abstract

BACKGROUND Gastric cancer is the second most common malignant tumor in China, ranking third among all malignant tumor mortality rates. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to increase significantly the effectiveness of intraperitoneal chemotherapeutic drugs, prolong the action time of these drugs on intraperitoneal tumor cells, and enhance their diffusion in tumor tissues. HIPEC may be one of the best choices for the eradication of residual cancer cells in the abdominal cavity. AIM The aim of this study was to study the role of preventive HIPEC after radical gastrectomy. METHODS A prospective analysis was performed with patients with cT 4 N 0-3 M 0 gastric cancer to compare the effects of postoperative prophylactic HIPEC plus intravenous chemotherapy with those of routine adjuvant chemotherapy. Patients’ medical records were analyzed, and differences in the peritoneal recurrence rate, disease-free survival time, and total survival time between groups were examined. RESULTS The first site of tumor recurrence was the peritoneum in 11 cases in the conventional adjuvant chemotherapy group and in 2 cases in the HIPEC group ( P = 0.020). The 1-year and 3-year disease-free survival rates were 91.9% and 60.4%, respectively, in the conventional adjuvant chemotherapy group and 92.1% and 63.0%, respectively, in the HIPEC group. The 1-year and 3-year overall survival rates were 95.2% and 66.3%, respectively, in the conventional adjuvant chemotherapy group and 96.1% and 68.6%, respectively, in the HIPEC group. No significant difference in postoperative or chemotherapy complications was observed between groups. CONCLUSION In patients with cT 4 N 0-3 M 0 gastric cancer, prophylactic HIPEC after radical tumor surgery is beneficial to reduce peritoneal tumor recurrence and prolong survival.

Intraperitoneal Chemotherapy Using Fluorouracil Implants Combined With Radical Resection and Postoperative Adjuvant Chemotherapy for Stage III Gastric Cancer: A Multi-Center, Randomized, Open-Label, Controlled Clinical Study

“…A growing number of studies have shown that intraoperative or postoperative intraperitoneal chemotherapy can dramatically reduce the risk of postoperative peritoneal recurrence and increase the survival rate ( 5 , 6 ). In recent years, intraoperative prophylactic intraperitoneal chemotherapy gradually becomes applied in clinical practice ( 7 , 8 ). The randomized controlled trial using hyperthermic intraperitoneal chemotherapy (HIPEC) in patients at risk for peritoneal metastases of gastric cancer was reported by Yonemura et al.…”

Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for the prevention and control of peritoneal metastasis in patients with gastrointestinal malignancies: a systematic review of randomized controlled trials

“…However, only limited studies are found in the medical literature that was done to assess the prophylactic role of HIPEC in the prevention and control of peritoneal metastasis of gastrointestinal origin. Xie et al (2020[ 34 ]) had done a non-RCT in China to study the role of prophylactic HIPEC after radical gastrectomy in patients with locally advanced gastric cancer. With results showing peritoneal recurrence rates of 4 % in the HIPEC group, the authors concluded that prophylactic HIPEC is beneficial in reducing the peritoneal recurrence rate and improving overall survival in patients with locally advanced gastric cancer.…”

Is Prophylactic Hyperthermic Intraperitoneal Chemotherapy Beneficial to the Long-Term Survival of Patients After Radical Gastric Cancer Surgery: A Systematic Review and Meta-Analysis

“…Four studies (2RCTs, 3NRCTs), 415 patients were reported overall 1-year survival [25,26,28,34,43]. Analyzing under the random effects model, the overall heterogeneity (I 2 =62%) is acceptable.…”

“…Among them, 9 studies were published after 2015. Most of the included studies are from Asia, including 8 from mainland China [23][24][25][26][27][28][29] and Taiwan ROC [30], 10 from Japan [31][32][33][34][35][36][37][38][39] and Korea [40]. The other three studies are from Belarus [41], Italy [42], Ukraine [43], and Brazil [44]…”

“…The HIPEC protocol chosen by cui and his colleagues[28] is as follows: Cisplatin (60 mg/m 2 ) and 0.9% sodium chloride solution (3000 mL) at 1,4days; uorouracil (0.75 g) and 0.9% sodium chloride solution (3000 mL) at 2 ,3days; Dexamethasone (10 mg) and 2% lidocaine (10 mL) 1-4days; temperature: 41-43˚C. Xie [25] reported blinding the researchers responsible for data statistics, and none of the other studies mentioned blinding. In addition, the simple size is small in two studies [32,36], and there may be a risk of reporting bias.…”