Treatment of patients with peritoneal metastases from gastric cancer

Abstract

Despite recent advances in chemotherapy, outcomes of patients with peritoneal metastases (PM) from gastric cancer are still very poor and standard treatment has not been established. Although oral S‐1 appears to be effective for patients with PM, the effects of systemic chemotherapy are limited. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) yield fewer benefits in patients with PM from gastric cancer than in patients with PM from other malignancies. In comparison, repeated intraperitoneal chemotherapy (RIPEC) with taxanes using an implantable peritoneal access port has a pharmacokinetic advantage for the control of peritoneal lesions and in combination with systemic chemotherapy can result in surprisingly long‐term survival in patients with PM from gastric cancer. Herein, we review the results of recent clinical studies specifically targeting PM from gastric cancer and discuss future prospects for an intraperitoneal approach to the ideal treatment of patients with gastric cancer with peritoneal involvement.

Bidirectional treatment of peritoneal metastasis with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy: a systematic review

“…Objective local tumor response rates to PIPAC above 50% have been reported in patients with PM from a wide variety of primary cancers [8], without compromising the patient's quality of life (QoL) [8]. Bidirectional treatment strategies, not involving PIPAC, have been used and studied extensively and have shown improvement in overall and progression free survival compared to intraperitoneal treatment alone in patients with advanced ovarian or gastric cancers [9][10][11][12].…”

Neoadjuvant systemic and hyperthermic intraperitoneal chemotherapy combined with cytoreductive surgery for gastric cancer patients with limited peritoneal metastasis: a prospective cohort study

“…Peritoneal metastasis has poor prognosis, and is a major cause of death in patients with advanced gastric cancer. In the past, systemic chemotherapy was the main treatment option for these patients [19].…”

Integrated fluorescent cytology with nano‐biologics in peritoneally disseminated gastric cancer

“…We hypothesize that these unique features of the TelomeScan approach would assist in identifying a subpopulation of patients with particularly poor prognosis among those who are cytology positive on conventional methods. Therefore, combining TelomeScan‐guided cytology with conventional cytology may have the potential to improve prognostic discrimination and patient stratification, to determine, for example, the appropriate application of intraperitoneal chemotherapy or more intensive combination chemotherapy, or avoiding non‐beneficial invasive surgery …”

“…Therefore, combining TelomeScan-guided cytology with conventional cytology may have the potential to improve prognostic discrimination and patient stratification, to determine, for example, the appropriate application of intraperitoneal chemotherapy or more intensive combination chemotherapy, or avoiding non-beneficial invasive surgery. [24][25][26][27] Immunocytochemistry involving the use of epithelial markers for the identification of cancer cells has been reported to improve the accuracy of cytology. Cancer cells, however, do not always express epithelial marker proteins such as EpCAM and E-cadherin, particularly during metastasis, when cancer cells may undergo the process of EMT.…”