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Prophylactic chemotherapeutic hyperthermic intraperitoneal perfusion reduces peritoneal metastasis in gastric cancer: a retrospective clinical study.

ABSTRACT: BACKGROUND:Peritoneal metastasis is the most frequent failure in gastric cancer. This study evaluated the role of prophylactic chemotherapeutic hyperthermic intraperitoneal perfusion (CHIP) in patients after D2 dissection. METHODS:Gastric cancer patients after D2 dissection were enrolled in this study. Patients received either chemotherapy (IV group) or CHIP (CHIP group). Sites of recurrence or metastasis, disease-free survival (DFS), overall survival (OS) and adverse events were evaluated. RESULTS:Twenty-two patients received CHIP treatment, and 21 patients received chemotherapy alone. The median DFS time was 24.5 and 36.5?months in the IV group and CHIP group (P?=?0.044), respectively. The median OS time was 33.1?months in the IV group and not reached in the CHIP group (P?=?0.037). We also found that CHIP could reduce the total recurrence/metastasis rate, especially that of peritoneal metastasis. In the subgroup analysis, DFS and OS were both superior in deficient mismatch repair (dMMR) patients than in proficient MMR (pMMR) patients. CONCLUSION:This hypothesis-generating study indicates that CHIP might be feasible for gastric cancer patients after D2 resection.

SUBMITTER: Zhu L

PROVIDER: S-EPMC7461269 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Prophylactic chemotherapeutic hyperthermic intraperitoneal perfusion reduces peritoneal metastasis in gastric cancer: a retrospective clinical study.

Zhu Lucheng L Xu Zhizheng Z Wu Yajun Y Liu Pengyuan P Qian Jianing J Yu Shuhuan S Xia Bing B Lai Jianjun J Ma Shenglin S Wu Zhibing Z

BMC cancer 20200831 1

<h4>Background</h4>Peritoneal metastasis is the most frequent failure in gastric cancer. This study evaluated the role of prophylactic chemotherapeutic hyperthermic intraperitoneal perfusion (CHIP) in patients after D2 dissection.<h4>Methods</h4>Gastric cancer patients after D2 dissection were enrolled in this study. Patients received either chemotherapy (IV group) or CHIP (CHIP group). Sites of recurrence or metastasis, disease-free survival (DFS), overall survival (OS) and adverse events were ...[more]

PMID: 32867714

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Project description:BACKGROUND:There is no currently available treatment for peritoneal metastasis of gastric cancer. This phase II study aimed to evaluate the efficacy and safety of neoadjuvant systemic chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) for the treatment of these patients. METHODS:Neoadjuvant chemotherapy comprised two cycles of HIPEC and four cycles of S-1 plus paclitaxel. HIPEC was administered intraperitoneally with paclitaxel (75?mg/m2). For systemic chemotherapy, paclitaxel was administered intravenously(150?mg/m2) on day 1, and S-1 was administered orally(80?mg/m2/day)on days 1-14 of a 3-week?cycle. Another two cycles of HIPEC and four cycles of S-1 plus paclitaxel were administered after second diagnostic staging laparoscopy or CRS. The primary endpoints were treatment efficiency and safety; the secondary endpoint was 3-year overall survival (OS). RESULTS:A total of 40 patients were enrolled and 38 patients have been analyzed. Of these, 18 (47.4%) patients received neoadjuvant systemic chemotherapy, HIPEC and CRS (conversion therapy group), while 20 patients received only chemotherapy and HIPEC (palliative chemotherapy group). Median OS was markedly improved in the conversion therapy group (21.1?months, 95% confidence interval [CI] 16.7-25.6?months) in comparison with the palliative chemotherapy group(10.8?months, 95%CI 7.3-14.2?months, p?=?0.002). After neoadjuvant systemic chemotherapy and HIPEC, a second laparoscopic exploration was performed, and the prognosis of patients with low peritoneal cancer index (PCI) (PCI?<?6) was significantly better than that of patients with high PCI (PCI???6)(20.1 vs.11.3?months, p?=?0.006). CONCLUSION:Neoadjuvant systemic chemotherapy and HIPEC combined with CRS is safe and feasible, and could potentially improve the prognosis of gastric cancer patients with limited peritoneal metastasis. However, further clinical trials are still warranted. TRIAL REGISTRATION:This study has been registered with ClinicalTrials.gov as NCT02549911 . Trial registration date: 15/09/2015.

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Prophylactic chemotherapeutic hyperthermic intraperitoneal perfusion reduces peritoneal metastasis in gastric cancer: a retrospective clinical study.

Publications

Prophylactic chemotherapeutic hyperthermic intraperitoneal perfusion reduces peritoneal metastasis in gastric cancer: a retrospective clinical study.

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