Surgery with hyperthermic intraperitoneal chemotherapy after response to induction chemotherapy in patients with peritoneal metastasis of gastric cancer

Canbay, Emel; Torun, Bahar Canbay; Cosarcan, K; Altunal, Cetin; Gürbüz, Birgül; Bilgiç, Çağrı; Sezgin, Canfeza; Kaban, Kerim; Yılmaz, Serpil; Yazıcı, Zeliha

doi:10.21037/jgo-20-121

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…Five observational studies were included in the rapid review (see Supplemental Table 6). 46–50 In 2016, Boerner et al evaluated 38 consecutive GCPM patients that were treated with gastrectomy, CRS, and HIPEC and compared them to 27 patients who received chemotherapy with gastrectomy (PC-Standard). 47 They found that the CRS-HIPEC group had better overall, 1-year, 3-year and 5-year survival compared to the PC-Standard group.…”

Section: Resultsmentioning

confidence: 99%

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Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

Turaga

2024

Preprint

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Background: Gastric cancer with synchronous peritoneal metastases (GCPM) is a debilitating disease with limited treatment options. This manuscript describes an update of the 2018 Chicago Consensus Guidelines addressing the management of GCPM in line with most recent evidence. Methods: A clinical management pathway was updated through two rounds of a Delphi Consensus to assess agreement levels with pathway blocks. Supporting evidence underwent evaluation via a rapid literature review. Meta-analyses were performed where appropriate. Results: Overall, level of evidence in this disease subset was low to moderate. Of 124 participants in the first round, 109 (88%) responded in the second round. Strong consensus (>90%) was achieved in 6/8 (75%) blocks in round I and II. A multidisciplinary preoperative assessment and diagnostic laparoscopy should be offered all patients, while patients with a high burden of disease or progression should undergo non-surgical management. Patients with stable/responsive disease and low peritoneal carcinomatosis index should subsequently be offered treatment with regional therapeutic interventions and cytoreductive surgery. In patients who are cytology positive, systemic therapy can be used to convert these patients to cytology negative, with subsequent surgery offered per the goals of care. Meta-analysis of observational and randomized control trials revealed a survival benefit with the addition of intraperitoneal chemotherapy to cytoreductive surgery (HR 0.52). Conclusion: The consensus-driven clinical pathway for GCPMs offers vital clinical guidance for practitioners. There is a growing body of high-quality evidence to support management strategies and future clinical trials are eagerly awaited.

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Section: Resultsmentioning

confidence: 99%

“…In 2021, Canbay et al evaluated 53 patients with cytology positive or peritoneal metastases. 46 All patients underwent laparoscopic HIPEC followed by neoadjuvant intraperitoneal and systemic therapy. 34 of these patients went on to receive CRS and HIPEC, while 19 only underwent induction chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

Turaga

2024

Preprint

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“…This concept was first introduced by Yonemura et al (29) and is now being widely used to downstage patients with diffuse peritoneal involvement, making them amenable to CRS and HIPEC. Several studies have shown significant decrease in PCI with combined IP/IV treatments, as well as conversion of ascitic fluid cytology from positive to negative with acceptable grade 3 and 4 morbidity and mortality (25,27,30,31,56,60,90). Various regimens are available and very well summarized by Brandl et al with suggestions of regimens toward the latter part of the article with the intention to standardize these treatment protocols (53).…”

Section: Discussionmentioning

confidence: 99%

Gastric Cancer With Peritoneal Metastasis—A Comprehensive Review of Current Intraperitoneal Treatment Modalities

Prabhu¹,

Mishra²,

Brandl

et al. 2022

Front. Oncol.

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The treatment of patients with peritoneal metastasis from gastric cancer continues to evolve. With various forms of intraperitoneal drug delivery available, it is now possible to reach the sites of peritoneal metastases, which were otherwise sub-optimally covered by systemic chemotherapy, owing to the blood peritoneal barrier. We conducted a narrative review based on an extensive literature research, highlighting the current available intraperitoneal treatment options, which resulted in improved survival in well-selected patients of peritoneally metastasized gastric cancer. Intraperitoneal chemotherapy showed promising results in four different treatment modalities: prophylactic, neoadjuvant, adjuvant, and palliative. It is now possible to choose the type of intraperitoneal treatment/s in combination with systemic treatment/s, depending on patients’ general condition and peritoneal disease burden, thus providing individualized treatment to these patients. Randomized controlled trials for the different treatment modalities were mainly conducted in Asia and lack further validation in the other parts of the world. Most recent application tools, such as pressurized intraperitoneal aerosol chemotherapy, seem promising and need to pass the ongoing clinical trials.

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“…Ji et al believe that postoperative CC score is a prognostic factor, and the prognosis of patients with CCS-0 is good [ 27 ]. Many studies have shown that the PCI score can be used as an independent prognostic factor, and patients with a score < 7 can improve their prognosis after thermal perfusion [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

Hyperthermic intraperitoneal chemotherapy for patients with gastric cancer based on laboratory tests is safe: a single Chinese center analysis

Zheng

Sun³

et al. 2022

BMC Surg

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Purpose About 15%—40% of gastric cancer patients have peritoneal metastasis, which leads to poor prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) is considered to be an effective treatment for these patients. This study evaluated the efficacy and safety of HIPEC in patients with gastric cancer diagnosed from laboratory tests. Methods The clinical and pathological data of 63 patients with gastric cancer who underwent HIPEC in 2017–2021 were prospectively recorded. Fifty-five patients underwent cytoreductive surgery + HIPEC, and eight patients received HIPEC alone. The factors associated with HIPEC safety and efficacy were analyzed. The primary endpoint was overall survival. Results The average patient age was 54.84 years and 68.3% of patients were male. Moreover, 79.4% of patients had a peritoneal carcinoma index (PCI) score of ≤ 7 and 61.9% had a completeness of cytoreduction score of 0. Because of peritoneal metastasis, 29 patients (46.03%) were classified as stage IV. Laboratory tests showed no differences in pre-HIPEC blood test results compared to post-HIPEC results after removing the effects of surgery. HIPEC treatment did not cause obvious liver or kidney damage. Serum calcium levels decreased significantly after HIPEC ( P = 0.0018). The Karnofsky performance status (KPS) score correlated with the patient’s physical function and improved after HIPEC ( P = 0.0045). In coagulation tests, FDP ( P < 0.0001) and D-dimer ( P < 0.0001) levels increased significantly and CA242 ( P = 0.0159), CA724 ( P < 0.0001), and CEA ( P < 0.0014) levels decreased significantly after HIPEC. Completeness of cytoreduction score was an independent prognostic factor. HIPEC did not show a survival benefit in patients with gastric cancer ( P = 0.5505). Conclusion HIPEC is a safe treatment for patients with gastric cancer with peritoneal metastasis based on the laboratory tests. However, the efficacy of this treatment on gastric-derived peritoneal metastases requires further confirmation. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01795-6.

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Surgery with hyperthermic intraperitoneal chemotherapy after response to induction chemotherapy in patients with peritoneal metastasis of gastric cancer

Cited by 10 publications

References 33 publications

Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

Gastric Cancer With Peritoneal Metastasis—A Comprehensive Review of Current Intraperitoneal Treatment Modalities

Hyperthermic intraperitoneal chemotherapy for patients with gastric cancer based on laboratory tests is safe: a single Chinese center analysis

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