The Treatment of Peritoneal Carcinomatosis in Advanced Gastric Cancer: State of the Art

Montori, Giulia; Catena, Fausto; Ceresoli, Marco; Colaianni, Nicola; Poletti, Eugenio; Ansaloni, Luca

doi:10.1155/2014/912418

Cited by 71 publications

(71 citation statements)

References 32 publications

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“…It is possible that Mitomycin C, in colorectal PM, in the context of complete CRS, may yield superior survival results compared to oxaliplatin [120] . For gastric PM, catumaxomab seems to confirm positive results [119] , but in colorectal PM, bevacizumab leads to a double mortality rate after CRS HIPEC treatment [121] . Furthermore, as far as the array of CRS treatment is concerned, along with visceral resection and Perito nectomy procedures, surgery on the urinary tract was assessed.…”

Section: Pm Multimodal Treatment -Research Pathways (2010-2014)mentioning

confidence: 96%

“…There are definite reports regarding the results of perioperative neoadjuvant chemotherapy, demonstrated by histological response in colon cancer [117] and by increased survival in appendix cancer [118] . Likewise, in gastric cancer, survival benefits have been shown for perioperative neoadjuvant and early postoperative intraperitoneal chemotherapy [119] . The complexity of multimodal treatment approach is also certified by the wide range of cytostatic drugs and the occurrence of new principles.…”

Section: Pm Multimodal Treatment -Research Pathways (2010-2014)mentioning

confidence: 99%

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Multimodality treatment strategies have changed prognosis of peritoneal metastases

Lungoci

Mironiuc

Muntean

et al. 2016

WJGO

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For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with "terminal status/despair". The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists' perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams. Core tip: The multimodal treatment of peritoneal metastases (PM), involving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, has been strenuously achieved over time, but seems to be the best treatment option, for selected cases. This paper addresses data about the multimodal treatment strategy, focused to patient's survival, the key indicator for assessing results, in the case of PM. Also, it were highlighted the treatment key aspects and the controversies, high in the 35 years of treatment implementing. By understanding the philosophy of multimodal treatment, physicians will be able to offer an alternative to the routine systemic chemotherapy.Lungoci C, Mironiuc AI, Muntean V, Oniu T, Leebmann H, Mayr M, Piso P. Multimodality treatment strategies have changed prognosis of peritoneal metastases.

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Section: Pm Multimodal Treatment -Research Pathways (2010-2014)mentioning

confidence: 96%

Section: Pm Multimodal Treatment -Research Pathways (2010-2014)mentioning

confidence: 99%

Multimodality treatment strategies have changed prognosis of peritoneal metastases

Lungoci

Mironiuc

Muntean

et al. 2016

WJGO

View full text Add to dashboard Cite

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“…They are found intraoperatively during planned surgical resection in 10%-20% of patients, will develop in 20%-50% of patients after curative surgery (15) and are the cause of death in 60% of gastric cancer patients. (16) Traditionally, PM with a gastric origin are considered distant metastases.…”

Section: Gastric Cancermentioning

confidence: 99%

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal cancers: fad or standard of care?

Teo

Tan

2018

smedj

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Peritoneal metastases (PM) are the common endpoint for patients with advanced gastrointestinal cancers.PM from these cancers are often managed in a similar fashion to other sites of systemic metastases, but the following must be taken into consideration. (a) PM do not respond to systemic chemotherapy in the same fashion as liver and lung metastases. (b) PM cause local problems, resulting in disruption of chemotherapy. (c) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) actually work for PM. (d) PM are not easily detected on imaging modalities. There has been mounting evidence of the effectiveness of CRS-HIPEC at prolonging survival in selected patients with colorectal and gastric PM, but there remains a reluctance to explore this treatment modality. This is likely because of the perceived morbidity and mortality. An effective management strategy employing CRS-HIPEC for selected patients with gastrointestinal PM can only be achieved if a concerted effort is made to understand this disease and address the concerns regarding this treatment.

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“…20 These include early postoperative chemotherapy (EPIC), 53,54 and neoadjuvant intraperitoneal and systemic chemotherapy (NIPS). 55 A number of randomized clinical trials are underway to evaluate both EPIC and NIPS in gastric cancer with PC. These chemotherapies are not without controversy.…”

Section: Crs-hipec and The Standard Of Carementioning

confidence: 99%

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

Smith¹,

Kirkpatrick²,

Thomas³

et al. 2017

GICTT

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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective treatment in a variety of cancers with peritoneal carcinomatosis (PC), especially in pseudomyxoma peritonei for which it is the standard of care. The data for gastric cancer are not as conclusive. This review discusses the effect of HIPEC on gastric cancer survival, the importance of patient selection, the effect of HIPEC on gastric cancer morbidity, translational research on HIPEC, and other recent research on HIPEC in the setting of gastric cancer and/or peritoneal metastases. CRS-HIPEC has been shown to be superior to either CRS alone or systemic chemotherapy alone in terms of improving survival. CRS-HIPEC seems to be the best current treatment for patients with gastric cancer and peritoneal metastases. The international community has recommended it as the treatment for this disease. Prudent patient selection before CRS-HIPEC is recommended as subgroups of patients have been shown to benefit from the treatment, while others have not. Studies on CRS-HIPEC have shown the procedure to have acceptably low rates of morbidity and peri-and postoperative complications as well as significant reductions in the incidence of ascites associated with PC. Translational research on HIPEC supports its use as prophylaxis for prevention of peritoneal metastasis and demonstrates HIPEC to be both effective and safe. Measurement of the tumor marker carcinoembryonic antigen has been shown to be an effective indicator of future outcomes in gastric cancer treated with CRS-HIPEC. Although the treatment outcomes have improved, even current treatment using CRS-HIPEC for gastric cancer with PC the survival rates can be dismal. Thus, the treatment of advanced gastric cancer with PC is an ongoing field of study and future directions of the treatment of gastric cancer with PC may include the use of intraperitoneal immunotherapy.

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The Treatment of Peritoneal Carcinomatosis in Advanced Gastric Cancer: State of the Art

Cited by 71 publications

References 32 publications

Multimodality treatment strategies have changed prognosis of peritoneal metastases

Multimodality treatment strategies have changed prognosis of peritoneal metastases

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal cancers: fad or standard of care?

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

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