51
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Tan GHC, Shannon NB, Chia CS, Lee LS, Soo KC, Teo MCC. The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Asian J Urol 2017; 5:194-198. [PMID: 29988907 PMCID: PMC6033198 DOI: 10.1016/j.ajur.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/15/2017] [Accepted: 07/03/2017] [Indexed: 12/03/2022] Open
Abstract
Objective Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are increasingly being used to treat peritoneal malignancies. Urological resections and reconstruction (URR) are occasionally performed during the surgery. We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients. Methods A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed. Outcomes between patients who had surgery involving, and not involving URR were compared. Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit (ICU) and hospital. Secondary outcomes were that of overall survival (OS) and prognostic factors that would indicate a need for URR. Results A total of 214 CRS-HIPEC were performed, 21 of which involved a URR. Baseline clinical characteristics did not vary between the groups (URR vs. No URR). Urological resections comprised of 52% bladder resections, 24% ureteric resections, and 24% involving both bladder and ureteric resections. All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses, one ureto-uretostomy, five direct implantations into the bladder and three boari flaps. URR were more frequently required in patients with colorectal peritoneal disease (p = 0.029), but was not associated with previous pelvic surgery (76% vs. 54%, p = 0.065). Patients with URR did not suffer more serious complications (14% vs. 24%, p = 0.42). ICU (2.2 days vs. 1.4 days, p = 0.51) and hospital stays (18 days vs. 25 days, p = 0.094) were not significantly affected. Undergoing a URR did not affect OS (p = 0.99), but was associated with increased operation time (570 min vs. 490 min, p = 0.046). Conclusion While concomitant URR were associated with an increase in operation time, there were no significant differences in postoperative complications or OS. Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours, and needs to be considered during pre-operative planning.
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Affiliation(s)
| | | | | | - Lui Shiong Lee
- Department of Urology, Singapore General Hospital, Singapore
| | - Khee Chee Soo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Melissa Ching Ching Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
- Corresponding author.
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52
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Stange DE, Weitz J, Welsch T. Chirurgische Therapie von Adenokarzinomen des gastroösophagealen Übergangs und des Magens. DER GASTROENTEROLOGE 2017; 12:401-406. [DOI: 10.1007/s11377-017-0190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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53
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Hsieh MC, Lu CY, Chang WW, Wu SY, Hsiao PK, Liu TJ. Experiences with cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy in Taiwan. Medicine (Baltimore) 2017; 96:e7306. [PMID: 28658135 PMCID: PMC5500057 DOI: 10.1097/md.0000000000007306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Our hospital was the first institution to offer cytoreduction surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Taiwan. Therefore, we report our experience and outcomes among patients who underwent HIPEC.Since 2002, 164 eligible patients underwent HIPEC, and we excluded cases of laparoscopic or prophylactic HIPEC. The cases were categorized according to whether they were treated before 2012 (Period 1: 80 cases) or after 2012 (Period 2: 84 cases).The rates of surgical morbidity were 46.3% during Period 1 and 20.2% during Period 2 (P < .01), and the rates of severe complications were 25% during Period 1 and 9.5% during Period 2 (P < .01). The 5-year overall survival rate was 35.8%, with rates of 13.4% for gastric cancer, 27.3% for colon cancer, 70.0% for appendiceal cancer, and 52.4% for ovarian cancer (median follow-up: 34 months). The survival rate was 42.1% when we achieved a cytoreduction score of 0/1, compared with 21.1% in the group with a cytoreduction score of 2/3 (P < .01). Severe complications were associated with a 5-year survival rate of 23.4%, compared with 37.9% among cases without severe complications (P = .01). Complete cytoreduction was achieved in 78.6% of the patients if they underwent their first surgery at our hospital.We have become an experienced hospital for CRS plus HIPEC. Although our complication rate for CRS plus HIPEC was high, it was within the acceptable range. Long-term survival was achieved in a few cases.
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Affiliation(s)
- Mao-Chih Hsieh
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine
| | - Chang-Yun Lu
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
| | - Wei-Wen Chang
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
| | - Szu-Yuan Wu
- Department of Radiation Oncology, Wan Fang Hospital
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei
- Department of Biotechnology, Hungkuang University, Taichung, Taiwan
| | - Ping-Kun Hsiao
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
| | - Tse-Jia Liu
- Division of General Surgery, Department of Surgery, Wan Fang Hospital
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine
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54
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Chen XD, Mao CC, Wu RS, Zhang WT, Lin J, Sun XW, Chi CH, Lou N, Wang PF, Shen X, Zhu GB, Shen SR. Use of the combination of the preoperative platelet-to-lymphocyte ratio and tumor characteristics to predict peritoneal metastasis in patients with gastric cancer. PLoS One 2017; 12:e0175074. [PMID: 28384215 PMCID: PMC5383064 DOI: 10.1371/journal.pone.0175074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/19/2017] [Indexed: 12/18/2022] Open
Abstract
The aims of the present study were to evaluate the predictive value of the platelet-to-lymphocyte ratio for peritoneal metastasis in patients with gastric cancer and to construct an available preoperative prediction system for peritoneal metastasis. A total of 1080 patients with gastric cancer were enrolled in our study. The preoperative platelet-to-lymphocyte ratio and other serum markers and objective clinical tumor characteristics were evaluated by receiver operating characteristic curves. A logistic analysis was performed to determine the independent predictive indicators of peritoneal metastasis. A prediction system that included the independent predictive indicators was constructed and evaluated by receiver operating characteristic curves. Based on the receiver operating characteristic curves, the ideal platelet-to-lymphocyte ratio cutoff value to predict peritoneal metastasis was 131.00. The logistic analysis showed that the platelet-to-lymphocyte ratio was an independent indicator to predict peritoneal metastasis. The area under the receiver operating characteristic curve was 0.599. When integrating all independent indicators (i.e., platelet-to-lymphocyte ratio, invasion depth, lymphatic invasion, pathological type), the prediction system more reliably predicted peritoneal metastasis with a higher area under the receiver operating characteristic curve (0.769). The preoperative platelet-to-lymphocyte ratio was an indicator that could be used to predict peritoneal metastasis. Our prediction system could be a reliable instrument to discriminate between patients with gastric cancer with and those without peritoneal metastasis.
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Affiliation(s)
- Xiao-dong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chen-chen Mao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rui-sen Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei-teng Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ji Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang-wei Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chu-huai Chi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Neng Lou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Peng-fei Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guan-bao Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shu-rong Shen
- Department of Breast Surgery, Wenzhou integrated traditional Chinese and Western Medicine Hospital, Wenzhou, Zhejiang, China
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55
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Kobayashi D, Kodera Y. Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis. Gastric Cancer 2017; 20:111-121. [PMID: 27803990 DOI: 10.1007/s10120-016-0662-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/15/2016] [Indexed: 02/07/2023]
Abstract
Peritoneal metastasis is the most frequent pattern of gastric cancer recurrence or metastasis and is a definitive determinant of prognosis. However, an effective means of treating peritoneal disease has not yet been established. Systemic chemotherapy has only a limited effect on peritoneal metastasis, although some progress has been shown in terms of median survival time, especially among patients with a minimal or moderate disease burden. Clinical research related to intraperitoneal administration of anticancer drugs is currently underway. An advantage of intraperitoneal chemotherapy is the ability to achieve high concentrations of anticancer drugs in the peritoneal cavity and the direct exposure of peritoneal deposits and free cancer cells to those drugs. In addition, pharmacokinetic studies with taxanes have shown that these high intraperitoneal drug concentrations are sustained for a considerable length of time, allowing prolonged exposure. As taxanes are the most appropriate drugs for intraperitoneal administration, the development of repeated intraperitoneal chemotherapy using taxanes for gastric cancer peritoneal metastasis-either alone or in combination with systemic chemotherapy-has taken place over the past decade, mostly in Japan. Several phase II trials and a phase III trial have recently demonstrated the efficacy of this therapy, including median survival times of 14.4-24.6 months and one-year overall survival rates of 67-91%. These results may lead to the approval of intraperitoneal taxanes, especially paclitaxel, for official insurance coverage in the near future.
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Affiliation(s)
- Daisuke Kobayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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56
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Kono K, Yong WP, Okayama H, Shabbir A, Momma T, Ohki S, Takenoshita S, So J. Intraperitoneal chemotherapy for gastric cancer with peritoneal disease: experience from Singapore and Japan. Gastric Cancer 2017; 20:122-127. [PMID: 27766496 DOI: 10.1007/s10120-016-0660-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/10/2016] [Indexed: 02/07/2023]
Abstract
Among advanced gastric cancer cases, peritoneal dissemination is a life-threatening mode of metastasis, and any strategy to control peritoneal metastasis will significantly improve treatment outcomes. Since intraperitoneal administration of anticancer drugs can induce an extremely high concentration of drugs in the peritoneal cavity, intraperitoneal chemotherapy would appear to be a reasonable and promising strategy to control the peritoneal dissemination. However, it has been reported in the past that intraperitoneal administration of mitomycin C or cisplatin resulted in no significant clinical effects against peritoneal metastasis of gastric cancer. In contrast, intraperitoneal paclitaxel is expected to remain inside the peritoneal cavity due to its large molecular weight and fat solubility, leading to a high concentration of the drug in the peritoneal cavity. In fact, promising results in several phase II clinical trials using intraperitoneal paclitaxel have been reported, including a median survival time of 16.2-24.6 months and a 1-year overall survival rate of 69-78 %. Thereafter, a phase III randomized control study (PHOENIX-GC trial) with intraperitoneal paclitaxel plus systemic S-1 and intravenous paclitaxel in comparison to systemic S-1 plus cisplatin was conducted in Japan. Moreover, a phase II clinical trial of combination chemotherapy of intraperitoneal paclitaxel with systemic capecitabine plus oxaliplatin is currently ongoing in Singapore. In this review, based on clinical experience from Singapore and Japan, the clinical significance of intraperitoneal chemotherapy for gastric cancer with peritoneal disease is discussed.
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Affiliation(s)
- Koji Kono
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Department of Surgery, National University of Singapore, Singapore, Singapore.
- Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima, Japan.
| | - Wei-Peng Yong
- Department of Hematology-Oncology, National University of Singapore, Singapore, Singapore
| | - Hirokazu Okayama
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Asim Shabbir
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Tomoyuki Momma
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinji Ohki
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiichi Takenoshita
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jimmy So
- Department of Surgery, National University of Singapore, Singapore, Singapore
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57
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Ellison LM, Man Y, Stojadinovic A, Xin H, Avital I. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treatment of gastric cancer with peritoneal carcinomatosis. Chin J Cancer Res 2017; 29:86-92. [PMID: 28373757 PMCID: PMC5348479 DOI: 10.21147/j.issn.1000-9604.2017.01.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although gastric cancer with peritoneal carcinomatosis is associated with poor prognosis and is generally treated with palliative systemic therapy, recent studies have shown that cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may prove to be an efficacious treatment option. In addition to reviewing the natural history of gastric cancer with peritoneal carcinomatosis, this mini-review examines literature on the efficacy of CRS and HIPEC as compared to chemotherapy and surgical options. Both randomized and non-randomized studies were summarized with the emphasis focused on overall survival. In summary, CRS and HIPEC are indeed a promising treatment option for gastric cancer with peritoneal carcinomatosis and large randomized clinical trials are warranted.
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Affiliation(s)
- Lynne M Ellison
- Bon Secours Cancer Institute, Bon Secours Health System, Richmond, VA 23226, USA
| | - Yangao Man
- Bon Secours Cancer Institute, Bon Secours Health System, Richmond, VA 23226, USA
| | | | - Hongwu Xin
- Laboratory of Oncology, the First People's Hospital of Jingzhou City, the First Hospital and Clinical Medical School of Yangtze University, Jingzhou 434008, China; Laboratory of Oncology, Center for Molecular Medicine, Medical School, Yangtze University, Jingzhou 434023, China
| | - Itzhak Avital
- Bon Secours Cancer Institute, Bon Secours Health System, Richmond, VA 23226, USA
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58
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Tan G, Chia C, Kumar M, Choo SP, Chia J, Tham CK, Chua C, Soo KC, Teo M. 201 consecutive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in a single Asian tertiary centre. Int J Hyperthermia 2016; 33:288-294. [DOI: 10.1080/02656736.2016.1262064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Grace Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Claramae Chia
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mrinal Kumar
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Su Pin Choo
- Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - John Chia
- Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Chee Kian Tham
- Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Clarinda Chua
- Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Khee Chee Soo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Melissa Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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59
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Beeharry MK, Liu WT, Yao XX, Yan M, Zhu ZG. A critical analysis of the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy combo in the clinical management of advanced gastric cancer: an effective multimodality approach with scope for improvement. Transl Gastroenterol Hepatol 2016; 1:77. [PMID: 28138643 DOI: 10.21037/tgh.2016.08.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/16/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is manifested in up to 40% of gastric cancer (GC) patients, after which their 5-year survival drops to less than 5%. The currently most acceptable treatment option for advanced GC (AGC) is systemic chemo and radio therapies with however generally very unsatisfying results and this led to a resurgence of interest in regional therapies like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Small trials have indicated an association with prolonged survival when applying this technique to AGC manifesting with PC. High procedure-related morbidity and mortality associated with the CRS-HIPEC approach have however brought by a polemic on the merits of the latter: with the advent of regulatory approval of more effective as well as novel, more personalized treatment options in AGC, along with advances in tailoring investigational agents specifically for peritoneal delivery, there clearly is a need to outline the appropriate role of CRS-HIPEC in this disease. In a clear objective to improve the therapeutic efficiency of HIPEC, there have been immense developments in the technical aspects of this technology including the use of nanotechnology in more precise drug delivery systems (DDS) or choice of more efficient drugs such as gene-target technology, laparoscopy and so on. Henceforth, in this review, we will be highlighting the past and current status of the CRS + HIPEC procedure, shedding light on the pros and cons in order to boost up the efficiency of this multimodality approach.
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Affiliation(s)
- Maneesh K Beeharry
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wen-Tao Liu
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xue-Xin Yao
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Min Yan
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zheng-Gang Zhu
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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60
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Geng X, Liu H, Lin T, Hu Y, Chen H, Zhao L, Mou T, Qi X, Yu J, Li G. Survival benefit of gastrectomy for gastric cancer with peritoneal carcinomatosis: a propensity score-matched analysis. Cancer Med 2016; 5:2781-2791. [PMID: 27650694 PMCID: PMC5083731 DOI: 10.1002/cam4.877] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 12/23/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is the most frequent pattern of metastasis in stage IV gastric cancer (GC). The study aims to investigate the efficacy of gastrectomy in GC with PC. Clinicopathological data of 518 stage IV GC patients were retrospectively collected in Nanfang Hospital. Among all cases, 312 GC patients with PC (without other site of metastasis) were eligible. Univariate and multivariate analyses were performed to identify the independent prognostic factors. Propensity score matching analysis was performed to balance the characteristics and treatment‐related factors. There was a significantly improved overall survival in gastrectomy group (148 patients) compared with nonresection group (164 patients) (P < 0.001). The 1‐year and 2‐year survival rates were 49.8% and 21.5% in gastrectomy group, whereas 28.8% and 9.7% in nonresection group, respectively. Further analysis showed that gastrectomy had also improved survival in P1 (P = 0.017) and P2 stage patients (P < 0.001), but not P3 stage (P = 0.495). The modality of gastrectomy plus chemotherapy plus hyperthermic intraperitoneal chemotherapy (HIPEC) showed an optimum survival. In addition, P3 disease, nongastrectomy, nonchemotherapy, non‐HIPEC, and age ≥ 60 years were independently associated with poor survival. The gastrectomy plus chemotherapy plus HIPEC modality showed a significant survival benefit for gastric adenocarcinoma patients, particularly in those with P1 and P2 diseases.
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Affiliation(s)
- Xiuwen Geng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Gastrointestinal Surgery, The First People's Hospital of Yueyang, Yueyang, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tian Lin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaolong Qi
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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61
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Ji ZH, Peng KW, Li Y. Intraperitoneal free cancer cells in gastric cancer: pathology of peritoneal carcinomatosis and rationale for intraperitoneal chemotherapy/hyperthermic intraperitoneal chemotherapy in gastric cancer. Transl Gastroenterol Hepatol 2016; 1:69. [PMID: 28138635 DOI: 10.21037/tgh.2016.08.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/15/2016] [Indexed: 12/19/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is one of the most common causes of death in gastric cancer patients. Intraperitoneal free cancer cells (IFCCs) play a very important role in forming PC, but the administration of intraperitoneal chemotherapy (IPC) and/or hyperthermic intraperitoneal chemotherapy (HIPEC) could be an effective treatment for IFCCs. This review focuses on the origin of IFCCs, the mechanism of PC formatting, the rationale of IPC/HIPEC, and the current clinical trials on IPC/HIPEC to treat advanced gastric cancer patients.
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Affiliation(s)
- Zhong-He Ji
- Department of Peritoneal Cancer Surgery, Cancer Center of Beijing Shijitan Hospital affiliated to the Capital Medical University, Beijing 100038, China
| | - Kai-Wen Peng
- Department of Peritoneal Cancer Surgery, Cancer Center of Beijing Shijitan Hospital affiliated to the Capital Medical University, Beijing 100038, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Cancer Center of Beijing Shijitan Hospital affiliated to the Capital Medical University, Beijing 100038, China
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62
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Yonemura Y, Ishibashi H, Hirano M, Mizumoto A, Takeshita K, Noguchi K, Takao N, Ichinose M, Liu Y, Li Y. Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer. Ann Surg Oncol 2016; 24:478-485. [PMID: 27506661 DOI: 10.1245/s10434-016-5487-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated. MATERIALS AND METHODS In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied. RESULTS In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients. CONCLUSIONS NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.
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Affiliation(s)
- Yutaka Yonemura
- NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan. .,Department of Regional Cancer Therapies, Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Japan. .,Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan. .,Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
| | - Haruaki Ishibashi
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Masamitu Hirano
- Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Akiyoshi Mizumoto
- Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Kazuyosi Takeshita
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kousuke Noguchi
- Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Nobuyuki Takao
- Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Masumi Ichinose
- Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan
| | - Yang Liu
- NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan.,Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Yan Li
- Department of Peritoneal Surface Oncology, Beijing Shijitan Hospital of Capital Medical University, Beijing, China
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63
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Liu Y, Mizumoto A, Ishibashi H, Takeshita K, Hirano M, Ichinose M, Takegawa S, Yonemura Y. Should total gastrectomy and total colectomy be considered for selected patients with severe tumor burden of pseudomyxoma peritonei in cytoreductive surgery? Eur J Surg Oncol 2016; 42:1018-23. [DOI: 10.1016/j.ejso.2016.04.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/24/2016] [Accepted: 04/18/2016] [Indexed: 01/26/2023] Open
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Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy with lobaplatin and docetaxel to treat synchronous peritoneal carcinomatosis from gastric cancer: Results from a Chinese center. Eur J Surg Oncol 2016; 42:1024-34. [DOI: 10.1016/j.ejso.2016.04.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 12/29/2022] Open
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65
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Tu Y, Tian Y, Fang Z, Ruan Q, Tang H, Zhang X, Wu Y, Ding Y, Cui S. Cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion for the treatment of gastric cancer: A single-centre retrospective study. Int J Hyperthermia 2016; 32:587-94. [PMID: 27362668 DOI: 10.1080/02656736.2016.1190987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemoperfusion (HIPEC) is the treatment regime most likely to achieve prolonged survival in patients with peritoneal carcinomatosis from gastroenteric cancer. To date, few publications have focused on the treatment of patients with gastric cancer alone. Several controversies remain unsolved, including the safety and effectiveness of the CRS-HIPEC combination regime, particularly in cases where HIPEC is used as adjuvant treatment after CRS. Therefore, in the current study, we aimed to evaluate the safety and effectiveness of CRS combined with HIPEC in patients with gastric cancer. METHOD Data from 231 patients with a median age of 55.1 years treated with the CRS-HIPEC combination regime between January 2009 and December 2014 were retrospectively reviewed. All patients underwent the combination therapy (mean of 2.4 cycles per patient, range, 1 to 4 cycles). RESULTS Median overall survival was 37.0 months, with 1-, 2- and 3-year survival rates recorded as 83.4%, 68.5%, and 38.7%, respectively. The serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) were significantly decreased after combination therapy in the completeness of cytoreduction (CCR)-0 and CCR-1 groups, while no significant changes observed in marker levels were observed in the CC ≥2 group. The post-operative morbidity and mortality rates were 6.9% and 0.9%, respectively. Multivariate analysis revealed low TNM tumour stage, ascites condition and CCR score as independent predictors for better survival. CONCLUSION In view of the acceptable morbidity and mortality rates we propose that CRS combined with HIPEC presents an effective and safe treatment modality for patients with gastric cancer, especially in cases where optimal cytoreduction is achieved before the HIPEC procedure.
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Affiliation(s)
- Yinuo Tu
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Yunhong Tian
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Zhiyuan Fang
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Qiang Ruan
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Hongsheng Tang
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Xiangliang Zhang
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Yinbing Wu
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Yan Ding
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
| | - Shuzhong Cui
- a Cancer Centre of Guangzhou Medical University , Guangzhou , Guangdong Province , China
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Boerner T, Graichen A, Jeiter T, Zemann F, Renner P, März L, Soeder Y, Schlitt HJ, Piso P, Dahlke MH. CRS-HIPEC Prolongs Survival but is Not Curative for Patients with Peritoneal Carcinomatosis of Gastric Cancer. Ann Surg Oncol 2016; 23:3972-3977. [PMID: 27313067 DOI: 10.1245/s10434-016-5306-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Peritoneal carcinomatosis (PC) is a dismal feature of gastric cancer that most often is treated by systemic palliative chemotherapy. In this retrospective matched pairs-analysis, we sought to establish whether specific patient subgroups alternatively should be offered a multimodal therapy concept, including cytoreductive surgery (CRS) and intraoperative hyperthermic chemotherapy (HIPEC). METHODS Clinical outcomes of 38 consecutive patients treated with gastrectomy, CRS and HIPEC for advanced gastric cancer with PC were compared to patients treated by palliative management (with and without gastrectomy) and to patients with advanced gastric cancer with no evidence of PC. Kaplan-Meier survival curves and multivariate Cox regression models were applied. RESULTS Median survival time after gastrectomy was similar between patients receiving CRS-HIPEC and matched control patients operated for advanced gastric cancer without PC [18.1 months, confidence interval (CI) 10.1-26.0 vs. 21.8 months, CI 8.0-35.5 months], resulting in comparable 5-year survival (11.9 vs. 12.1 %). The median survival time after first diagnosis of PC for gastric cancer was 17.2 months (CI 10.1-24.2 months) in the CRS-HIPEC group compared with 11.0 months (CI 7.4-14.6 months) for those treated by gastrectomy and chemotherapy alone, resulting in a twofold increase of 2-year survival (35.8 vs. 16.9 %). CONCLUSIONS We provide retrospective evidence that multimodal treatment with gastrectomy, CRS, and HIPEC is associated with improved survival for patients with PC of advanced gastric cancer compared with gastrectomy and palliative chemotherapy alone. We also show that patients treated with CRS-HIPEC have comparable survival to matched control patients without PC. However, regardless of treatment scheme, all patients subsequently recur and die of disease.
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Affiliation(s)
- T Boerner
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - A Graichen
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - T Jeiter
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - F Zemann
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - P Renner
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - L März
- Department of Surgery, St. John of God Hospital Regensburg, Regensburg, Germany
| | - Y Soeder
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Piso
- Department of Surgery, St. John of God Hospital Regensburg, Regensburg, Germany
| | - M H Dahlke
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.
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67
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Yuan M, Wang Z, Hu G, Yang Y, Lv W, Lu F, Zhong H. A retrospective analysis of hyperthermic intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis. Mol Clin Oncol 2016; 5:395-399. [PMID: 27446587 DOI: 10.3892/mco.2016.918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/25/2016] [Indexed: 12/17/2022] Open
Abstract
Peritoneal metastasis (PM) is a poor prognostic factor in patients with gastric cancer. The aim of this study was to evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced gastric cancer with PM by retrospective analysis. A total of 54 gastric cancer patients with positive ascitic fluid cytology were included in this study: 23 patients were treated with systemic chemotherapy combined with HIPEC (HIPEC+ group) and 31 received systemic chemotherapy alone (HIPEC- group). The patients were divided into 4 categories according to the changes of ascites, namely disappear, decrease, stable and increase. The disappear + decrease rate in the HIPEC+ group was 82.60%, which was statistically significantly superior to that of the HIPEC- group (54.80%). The disappear + decrease + stable rate was 95.70% in the HIPEC+ group and 74.20% in the HIPEC- group, but the difference was not statistically significant. In 33 patients with complete survival data, including 12 from the HIPEC+ and 21 from the HIPEC- group, the median progression-free survival was 164 and 129 days, respectively, and the median overall survival (OS) was 494 and 223 days, respectively. In patients with ascites disappear/decrease/stable, the OS appeared to be better compared with that in patients with ascites increase, but the difference was not statistically significant. Further analysis revealed that patients with controlled disease (complete response + partial response + stable disease) may have a better OS compared with patients with progressive disease, with a statistically significant difference. The toxicities were well tolerated in both groups. Therefore, HIPEC was found to improve survival in advanced gastric cancer patients with PM, but the difference was not statistically significant, which may be attributed to the small number of cases. Further studies with larger samples are required to confirm our data.
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Affiliation(s)
- Meiqin Yuan
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Zeng Wang
- Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Guinv Hu
- Department of Surgical Oncology, Dongyang People's Hospital, Dongyang, Zhejiang 322100, P.R. China
| | - Yunshan Yang
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Wangxia Lv
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Fangxiao Lu
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Haijun Zhong
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
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68
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Chia CS, Seshadri RA, Kepenekian V, Vaudoyer D, Passot G, Glehen O. Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review. Pleura Peritoneum 2016; 1:67-77. [PMID: 30911610 PMCID: PMC6386497 DOI: 10.1515/pp-2016-0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/08/2016] [Indexed: 02/07/2023] Open
Abstract
Background: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer. Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer. Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction. Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.
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69
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Men HT, Gou HF, Liu JY, Li Q, Luo DEY, Bi F, Qiu M. Prognostic factors of intraperitoneal chemotherapy for peritoneal carcinomatosis of gastric cancer: A retrospective study from a single center. Oncol Lett 2016; 11:3501-3507. [PMID: 27123142 DOI: 10.3892/ol.2016.4403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 11/20/2015] [Indexed: 02/05/2023] Open
Abstract
Peritoneal carcinomatosis (PC) of gastric origin is currently recognized as a terminal disease with a poor prognosis. Advancements in novel therapeutic approaches, including intraperitoneal chemotherapy (IPC), have recently been made and it is believed that this may have contributed to the improved survival observed in patients with PC. The present study aimed to investigate overall survival (OS) and the associated prognostic factors in patients with PC of gastric origin who underwent IPC. A total of 57 patients were studied, with a median age of 51 years. The median follow-up time was 12.4 months. PC was diagnosed in all patients with gastric cancer. The median survival time of all patients was 10.1 months, whilst the OS rate at 1, 2 and 3 years was observed to be 46, 19 and 12%, respectively. Symptomatic ascites and a signet ring cell (SRC) histopathological type were demonstrated to signify a poor prognosis. Complete resection of all gross disease (CCR-0) and an increased number of cycles of systemic chemotherapy were independent factors that were observed to correlate with increased OS. The most common morbidities of grade 3/4 adverse effects were bone marrow suppression, nausea or vomiting, and diarrhea. In conclusion, IPC is an important treatment option for patients with PC that has originated from gastric cancer. Symptomatic ascites and SRC adenocarcinoma serve as negative clinicopathological prognostic factors, whilst CCR-0 and increased systemic chemotherapy cycles (≥4 cycles) may prove to be an important therapeutic option for PC patients.
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Affiliation(s)
- Hai-Tao Men
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China; Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong 400016, P.R. China
| | - Hong-Feng Gou
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ji-Yan Liu
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qiu Li
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - DE-Yun Luo
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Feng Bi
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Meng Qiu
- Division of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Huang O, Lu X, Xu X, Shi Y. Fibrin-sealant-delivered cisplatin chemotherapy versus cisplatin hyperthermic intraperitoneal perfusion chemotherapy for locally advanced gastric cancer without peritoneal metastases: a randomized phase-II clinical trial with a 40-month follow-up. Cell Biochem Biophys 2016; 71:1171-80. [PMID: 25398590 DOI: 10.1007/s12013-014-0326-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A new intraoperative cisplatin administration method for patients with locally advanced gastric cancer (AGC) and without peritoneal metastasis, fibrin-sealant-delivered cisplatin chemotherapy, was reported, and its safety, pharmacokinetics, and efficacy were compared with cisplatin hyperthermic intraperitoneal perfusion chemotherapy. Forty-two AGC patients were randomly divided into 2 groups: fibrin-sealant-delivered cisplatin chemotherapy (FS) (n = 21) and cisplatin hyperthermic intraperitoneal perfusion chemotherapy (CHIC) (n = 21). Both groups received 120 mg cisplatin after complete cytoreductive surgery. At different time points, cisplatin concentrations in patients' sera and urine samples were measured to determine time-dependent maximal concentration (Cmax) and the area under the curve (AUC). The primary and secondary end-points were overall survival (OS) and safety profiling, respectively. Occurrence of grade-3 to grade-4 liver or kidney dysfunction was less frequent in the FS group than in the CHIC group (28.6 % vs 47.6 %). Cisplatin Cmax and AUC for the serum and urine of the FS patients were significantly lower than that of the CHIC patients. Elimination half-life of cisplatin in the FS group was significantly longer than in the CHIC group (24.1 h vs 14.2 h). After a median follow-up of 40 months, 1-, 2-, and 3-years OS were 90.5 %, 71.4 %, and 61.9 % in the FS group, and 61.9 %, 47.6 %, and 42.8 % in the CHIC group, respectively. The median OS was 35.9 months in the FS group and 29.1 months in the CHIC group. Fibrin-sealant-delivered cisplatin chemotherapy was as effective and had a favorable pharmacokinetic profile with similar survival outcomes as cisplatin hyperthermic intraperitoneal perfusion chemotherapy following complete cytoreductive surgery of locally advanced GC without peritoneal metastases.
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Affiliation(s)
- Ou Huang
- Department of Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
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71
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Yonemura Y, Canbay E, Li Y, Coccolini F, Glehen O, Sugarbaker PH, Morris D, Moran B, Gonzaletz-Moreno S, Deraco M, Piso P, Elias D, Batlett D, Ishibashi H, Mizumoto A, Verwaal V, Mahtem H. A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent. Eur J Surg Oncol 2016; 42:1123-31. [PMID: 27160355 DOI: 10.1016/j.ejso.2016.03.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 12/29/2022] Open
Abstract
Recently, Peritoneal Surface Oncology Group International (PSOGI) developed a novel comprehensive treatment consisting of cytoreductive surgery (CRS) and perioperative chemotherapy (POC) for the treatment of peritoneal metastases (PM) from gastric cancer with curative intent. This article reviews the results of this treatment and verifies its indication. In this strategy, peritoneal cancer index (PCI) is determined by laparoscopy, and a peritoneal port is placed. Neoadjuvant bidirectional intraperitoneal/systemic chemotherapy (NIPS) is performed for 3 cycles, and then laparotomy is performed. Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemoperfusion (HIPEC) are performed. Multivariate analyses showed that completeness of cytoreduction, pathologic response to NIPS and PCI level and cytologic status after NIPS, as independent prognostic factors. PCI less than cut-off level after NIPS, negative cytology after NIPS, and positive response to NIPS were identified as the indications for comprehensive treatment. Patients who hold these criteria should be considered as the candidates for CRS and HIPEC.
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Affiliation(s)
- Y Yonemura
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan; NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, 600 8189, Japan.
| | - E Canbay
- NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, 600 8189, Japan
| | - Y Li
- Department of Peritoneal Surface Oncology, Beijin Shijitan Hospital of Capital Medical University, Beijin, 100038, China
| | - F Coccolini
- General Surgery Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - O Glehen
- Dēpartement de Chirurgie Gēnerale, Centre Hospitalier Lyon-Sud Hospices Civils de Lyon, Universitē Lyon, 69495, France
| | - P H Sugarbaker
- Center of Gastrointestinal Malignancies, Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - D Morris
- Department of Surgery, St George Hospital, University of New South Wales, Australia
| | - B Moran
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals Foundation Trust, Adelmaston Road, Basingstoke RG24 9NA, UK
| | - S Gonzaletz-Moreno
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Madrid, Spain
| | - M Deraco
- National Cancer Institute of Milan, Italy
| | - P Piso
- Krankenhaus Barmherzige Brieder, Teaching Hospital of the University of Regensburg, Regensburg, Germany
| | - D Elias
- Département de Chirurgie Générale, Institut Gustave Roussy, Villejuif, Cedex, France
| | - D Batlett
- Division of Surgical Oncology, Hillman Cancer Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA
| | - H Ishibashi
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan
| | - A Mizumoto
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan
| | - V Verwaal
- Oncologisch GE Chirurg, Catharina, Ziekenhuis Eindhoven, The Netherlands
| | - H Mahtem
- Department of Surgical Sciences, Uppsala University, Övriga Samarbeten, Akademiska Sjukhuset, Ing 70 1 Tr, 751 85, Uppsala, Sweden
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Feingold PL, Kwong MLM, Sabesan A, Sorber R, Rudloff U. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer and other less common disease histologies: is it time? J Gastrointest Oncol 2016; 7:87-98. [PMID: 26941987 DOI: 10.3978/j.issn.2078-6891.2015.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the fourth most commonly diagnosed cancer worldwide, and once spread to the peritoneum, has a 5-year survival of less than 5%. Recent years have demonstrated advances in the use of cytoreductive surgery (CRS) in combination with heated intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis due to various malignancies. The frequent desmoplastic stroma and poor vascularization impeding drug delivery particularly in the diffuse form of gastric cancer is thought to provide a sound rationale for a regionalized treatment approach in this disease. Here, we seek to review the available data to define the role of CRS and HIPEC in gastric cancer metastatic to the peritoneal surface, and furthermore, analyze the use of CRS and HIPEC in malignancies less commonly treated with the regionalized perfusion approach.
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Affiliation(s)
- Paul L Feingold
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mei Li M Kwong
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arvind Sabesan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Sorber
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Udo Rudloff
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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73
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Tan GHC, Ong WS, Chia CS, Tham CK, Soo KC, Teo MCC. Does early post-operative intraperitoneal chemotherapy (EPIC) for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) make a difference? Int J Hyperthermia 2016; 32:281-8. [PMID: 26862667 DOI: 10.3109/02656736.2015.1135485] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Peritoneal carcinomatosis (PC) is increasingly being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), with or without early post-operative intraperitoneal chemotherapy (EPIC). We compared the morbidities, overall survival (OS) and disease free survival (DFS) between two groups of patients who underwent CRS and HIPEC alone and with EPIC at our institution. METHODS A retrospective review of 111 patients with PC who were treated with CRS + HIPEC or CRS + HIPEC + EPIC in a single institution between January 2008 and April 2014 was performed. EPIC with 5-fluorouracil or paclitaxel was utilised, depending on the primary tumour. RESULTS Patients who received EPIC had a higher proportion of grade III and above post- operative complications (58% versus 25%; p = 0.048) and a longer duration of hospitalisation (16 days versus 13 days; p = 0.019) than patients without EPIC. There were no significant OS and DFS differences between the EPIC and no EPIC groups (log-rank p = 0.231 and p = 0.144, respectively). CONCLUSION The use of EPIC after CRS + HIPEC for PC potentially results in increased morbidity and longer hospitalisation, and is unlikely to affect survival outcomes. Based on our experience, EPIC is not recommended after CRS and HIPEC.
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Affiliation(s)
- Grace Hwei Ching Tan
- a Department of Surgical Oncology , National Cancer Centre Singapore , Singapore
| | - Whee Sze Ong
- a Department of Surgical Oncology , National Cancer Centre Singapore , Singapore
| | - Claramae Shulyn Chia
- a Department of Surgical Oncology , National Cancer Centre Singapore , Singapore
| | - Chee Kian Tham
- a Department of Surgical Oncology , National Cancer Centre Singapore , Singapore
| | - Khee Chee Soo
- a Department of Surgical Oncology , National Cancer Centre Singapore , Singapore
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The Role of Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer. Indian J Surg Oncol 2016; 7:198-207. [PMID: 27065710 DOI: 10.1007/s13193-016-0502-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 12/26/2022] Open
Abstract
Peritoneal metastasis, either synchronous or metachronous, is commonly seen in gastric cancer. It is associated with a poor prognosis, with a median survival of less than one year. The outcomes are not significantly improved by the use of systemic chemotherapy. We review the relevant literature on the role of HIPEC in gastric cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in three situations in gastric cancer. Besides its role as a definitive treatment in patients with established peritoneal metastasis (PM), it has been used as a prophylaxis against peritoneal recurrence after curative surgery and also as a palliative treatment in advanced peritoneal metastasis with intractable ascites. While prophylactic HIPEC has been shown to reduce peritoneal recurrence and improve survival in many randomised trials, palliative HIPEC can reduce the need for frequent paracentesis. Although CRS with HIPEC has shown promise in increasing the survival of selected patients with established PM from gastric cancer, larger studies are needed before this can be accepted as a standard of care.
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75
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Seshadri RA, Glehen O. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer. World J Gastroenterol 2016; 22:1114-30. [PMID: 26811651 PMCID: PMC4716024 DOI: 10.3748/wjg.v22.i3.1114] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer associated peritoneal carcinomatosis (GCPC) has a poor prognosis with a median survival of less than one year. Systemic chemotherapy including targeted agents has not been found to significantly increase the survival in GCPC. Since recurrent gastric cancer remains confined to the abdominal cavity in many patients, regional therapies like aggressive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been investigated for GCPC. HIPEC has been used for three indications in GC- as an adjuvant therapy after a curative surgery, HIPEC has been shown to improve survival and reduce peritoneal recurrences in many randomised trials in Asian countries; as a definitive treatment in established PC, HIPEC along with CRS is the only therapeutic modality that has resulted in long-term survival in select groups of patients; as a palliative treatment in advanced PC with intractable ascites, HIPEC has been shown to control ascites and reduce the need for frequent paracentesis. While the results of randomised trials of adjuvant HIPEC from western centres are awaited, the role of HIPEC in the treatment of GCPC is still evolving and needs larger studies before it is accepted as a standard of care.
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Diagnostic Laparoscopy in the Pre-operative Assessment of Patients Undergoing Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancies. Indian J Surg Oncol 2016; 7:230-5. [PMID: 27065714 DOI: 10.1007/s13193-015-0486-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/28/2015] [Indexed: 12/29/2022] Open
Abstract
The introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has led to an improvement in the survival of select patients with peritoneal surface malignancies (PSM). However, it is important to carefully identify patients who will benefit from this procedure and to avoid an unnecessary laparotomy in those who will not. The currently available imaging modalities are unable to accurately predict the peritoneal cancer index (PCI) score or the completeness of cytoreduction. In this article, we review the current status of staging laparoscopy in the assessment of patients with PSM who are planned for CRS & HIPEC. We discuss the patient selection, techniques, complications and efficacy of staging laparoscopy. To summarise, staging laparoscopy is a safe and feasible method of pre-operative assessment of patients with PSM. It has a high sensitivity and positive predictive value in identifying patients who can undergo a complete cytoreduction, thereby preventing many patients from undergoing an unnecessary laparotomy. With the exception of pseudomyxoma peritonei, it should be considered as a part of the routine assessment of patients with PSM who are being considered for CRS & HIPEC.
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77
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Chia CS, You B, Decullier E, Vaudoyer D, Lorimier G, Abboud K, Bereder JM, Arvieux C, Boschetti G, Glehen O. Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility? Ann Surg Oncol 2016; 23:1971-9. [PMID: 26753751 DOI: 10.1245/s10434-015-5081-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis is an increasingly common finding in gastric carcinoma. Previously, patients were treated as terminal, and median survival was poor. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this context is still highly debatable. OBJECTIVE The aim of this study was to evaluate the long-term outcomes associated with CRS and HIPEC, and define prognostic factors for cure, if possible. PATIENTS AND METHODS All patients with gastric carcinomatosis from five French institutions who underwent combined complete CRS and HIPEC and had a minimum follow-up of 5 years were included in this study. Cure was defined as a disease-free interval of more than 5 years from the last treatment until the last follow-up. RESULTS Of the 81 patients who underwent CRS and HIPEC from 1989 to 2009, 59 had a completeness of cytoreduction score (CCS) of 0 (complete macroscopic resection), and the median Peritoneal Cancer Index (PCI) score was 6. Mitomycin C was the most commonly used drug during HIPEC (88 %). The 5-year overall survival (OS) rate was 18 %, with nine patients still disease-free at 5 years, for a cure rate of 11 %. All 'cured' patients had a PCI score below 7 and a CCS of 0. Factors associated with improved OS on multivariate analysis were synchronous resection (p = 0.02), a lower PCI score (p = 0.12), and the CCS (p = 0.09). CONCLUSION The cure rate of 11 % for patients with gastric carcinomatosis who are deemed terminal emphasizes that CRS and HIPEC should be considered in highly selected patients (low disease extent and complete CRS).
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Affiliation(s)
- C S Chia
- Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France.
| | - B You
- Hospices Civils de Lyon, Department of Oncology, Cancer Institute of HCL, Pierre Bénite, France.,Université Lyon 1, Research Unit EMR 3738, Lyon, France
| | - E Decullier
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France.,Université de Lyon, RECIF, EA Santé Individu Société 4129, Lyon, France.,Université Lyon 1, Lyon, France
| | - D Vaudoyer
- Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France
| | - G Lorimier
- Service de Chirurgie Digestive et Cancérologique, Centre P. Papin, Angers, France
| | - K Abboud
- Service de Chirurgie Générale, Hopital Nord, St Etienne, France.,Université Lyon 1, Research Unit EMR 3738, Lyon, France
| | - J-M Bereder
- Service de Chirurgie Générale et Cancérologie Digestive, CHU L'Archet II, Nice, France
| | - C Arvieux
- Service de Chirurgie Digestive, CHU A. Michallon, Grenoble, France.,Université Lyon 1, Research Unit EMR 3738, Lyon, France
| | - G Boschetti
- Department of Hepatogastroenterology, Cancer Institute of HCL, Lyon Sud, Pierre Bénite, France
| | - O Glehen
- Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France.,Université Lyon 1, Research Unit EMR 3738, Lyon, France.,Surgical Oncology Department, CHRU Lyon Sud, Pierre Bénite, Cedex, France
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78
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Polom K, Marano L, Roviello G, Petrioli R, Piagnerelli R, de Franco L, Marrelli D, Roviello F. Evolution and emerging future of cytoreducxtive surgery and hyperthermic intraperitoneal chemoperfusion in gastric cancer: From treating the incurable to preventing recurrence. Int J Hyperthermia 2015; 32:173-9. [DOI: 10.3109/02656736.2015.1111432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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79
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Yamaguchi H, Kitayama J, Ishigami H, Kazama S, Nozawa H, Kawai K, Hata K, Kiyomatsu T, Tanaka T, Tanaka J, Nishikawa T, Otani K, Yasuda K, Ishihara S, Sunami E, Watanabe T. Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes. World J Gastrointest Oncol 2015; 7:285-291. [PMID: 26600928 PMCID: PMC4644851 DOI: 10.4251/wjgo.v7.i11.285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/28/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023] Open
Abstract
The effect of chemotherapy on peritoneal carcinomatosis (PC) of gastric cancer remains unclear. Recently, the intraperitoneal (IP) administration of taxanes [e.g., paclitaxel (PTX) and docetaxel (DOC)] during the perioperative period has shown promising results. Herein, we summarized the rationale and methodology for using IP chemotherapy with taxanes and reviewed the clinical results. IP administered taxanes remain in the IP space at an extremely high concentration for 48-72 h. The drug directly infiltrates peritoneal metastatic nodules from the surface and then produces antitumor effects, making it ideal for IP chemotherapy. There are two types of perioperative IP chemotherapy with taxanes: neoadjuvant intraperitoneal and systemic chemotherapy and sequential perioperative intraperitoneal chemotherapy (SPIC). In SPIC, patients receive neoadjuvant IP chemotherapy and the same regimen of IP chemotherapy after cytoreductive surgery (CRS) until disease progression. Usually, a taxane dissolved in 500-1000 mL of saline at ordinary temperature is administered through an IP access port on an outpatient basis. According to phase I studies, the recommended doses (RD) are as follows: IP DOC, 45-60 mg/m2; IP PTX [without intravenous (IV) PTX], 80 mg/m2; and IP PTX (with IV PTX), 20 mg/m2. Phase II studies have reported a median survival time of 14.4-24.6 mo with a 1-year overall survival of 67%-78%. A phase III study comparing S-1 in combination with IP and IV PTX to S-1 with IV cisplatin started in 2011. The prognosis of patients who underwent CRS was better than that of those who did not; however, this was partly due to selection bias. Although several phase II studies have shown promising results, a randomized controlled study is needed to validate the effectiveness of IP chemotherapy with taxanes for PC of gastric cancer.
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80
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Cardi M, Sammartino P, Mingarelli V, Sibio S, Accarpio F, Biacchi D, Musio D, Sollazzo B, Di Giorgio A. Cytoreduction and HIPEC in the treatment of "unconventional" secondary peritoneal carcinomatosis. World J Surg Oncol 2015; 13:305. [PMID: 26493405 PMCID: PMC4618525 DOI: 10.1186/s12957-015-0703-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/22/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Peritoneal metastasis (PM) is considered a terminal and incurable disease. In the last 30 years, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically changed the therapeutic approach for these patients and is regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas. Improved survival has also been reported in treating PM from ovarian, gastric, and colorectal cancers. However, PM often seriously complicates the clinical course of patients with other primary digestive and non-digestive cancers. There is increasing literature evidence that helped to identify not only the primary tumors for which CRS and HIPEC showed a survival advantage but also the patients who may benefit form this treatment modality for the potential lethal complications. Our goal is to report our experience with cytoreduction and HIPEC in patients with PM from rare or unusual primary tumors, discussing possible "unconventional" indications, outcome, and the peculiar issues related to each tumor. METHODS From a series of 253 consecutive patients with a diagnosis of peritoneal carcinomatosis and treated by CRS and HIPEC, we selected only those with secondary peritoneal carcinomatosis from rare or unusual primary tumors, excluding pseudomyxoma peritonei, peritoneal mesotheliomas, ovarian, gastric, and colorectal cancers. Complications and adverse effects were graded from 0 to 5 according to the WHO Common Toxicity Criteria for Adverse Events (CTCAE). Survival was expressed as mean and median. RESULTS We admitted and treated by CRS and HIPEC 28 patients with secondary peritoneal carcinomatosis from rare or unusual primary tumors. Morbidity and mortality rates were in line with those reported for similar procedures. Median survival for the study group was 56 months, and 5-year overall survival reached 40.3 %, with a difference between patients with no (CC0) and minimal (CC1) residual disease (52.3 vs. 25.7), not reaching statistical significance. Ten patients are alive disease-free, and eight are alive with disease. CONCLUSIONS Cytoreduction and HIPEC should not be excluded "a priori" for the treatment of peritoneal metastases from unconventional primary tumors. This combined therapeutic approach, performed in an experienced center, is safe and can provide a survival benefit over conventional palliative treatments.
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Affiliation(s)
- Maurizio Cardi
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. .,, Via Bolzano 32, 00198, Rome, Italy.
| | - Paolo Sammartino
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Valentina Mingarelli
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Simone Sibio
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Fabio Accarpio
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Daniele Biacchi
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Daniela Musio
- Dipartimento di Scienze Radioterapiche, Oncologiche ed Anatomopatologiche, "Sapienza" Università di Roma, Rome, Italy.
| | - Bianca Sollazzo
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Angelo Di Giorgio
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
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81
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Maeda H, Kobayashi M, Sakamoto J. Evaluation and treatment of malignant ascites secondary to gastric cancer. World J Gastroenterol 2015; 21:10936-10947. [PMID: 26494952 PMCID: PMC4607895 DOI: 10.3748/wjg.v21.i39.10936] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/26/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Malignant ascites affects approximately 10% of patients with gastric cancer (GC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in GC patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points (named “five-point method”) on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, “Clinical Benefit Response in GC (CBR-GC)”, was recently introduced to measure the efficacy of chemotherapy for malignant ascites of GC. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for GC patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targeting therapy. Although each treatment option is valid, further research is imperative to establish the optimal choice for each patient.
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82
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Canbay E, Torun BC, Torun ES, Yonemura Y. Evolution of management in peritoneal surface malignancies. ULUSAL CERRAHI DERGISI 2015; 32:203-7. [PMID: 27528813 DOI: 10.5152/ucd.2016.3375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/17/2015] [Indexed: 12/29/2022]
Abstract
Management of peritoneal surface malignancies has gradually evolved by the introduction of cytoreductive surgery in combination with intraperitoneal chemotherapy applications. Recently, peritoneal metastases of intraabdominal solid organ tumors and primary peritoneal malignancies such as peritoneal mesothelioma are being treated with this new approach. Selection criteria are important to reduce morbidity and mortality rates of patients who will experience minimal or no benefit from these combined treatment modalities. Management of peritoneal surface malignancies with this current trend is presented in this review.
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Affiliation(s)
- Emel Canbay
- NPO HIPEC Istanbul, Centermed, İstanbul, Turkey; NPO to Support Peritoneal Dissemination Treatment, 1-26 Harukimotomachi, Kishiwada City, Osaka, Japan
| | - Bahar Canbay Torun
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ege Sinan Torun
- Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Yutaka Yonemura
- NPO HIPEC Istanbul, Centermed, İstanbul, Turkey; NPO to Support Peritoneal Dissemination Treatment, 1-26 Harukimotomachi, Kishiwada City, Osaka, Japan
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83
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Bommareddi SR, Simianu VV, Mann LV, Mann GN. High-quality results of cytoreductive surgery and heated intraperitoneal chemotherapy perfusion for carcinomatosis at a low volume institution. J Surg Oncol 2015; 112:219-24. [PMID: 26274508 DOI: 10.1002/jso.23985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/10/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Maximal cytoreductive surgery (CS) with heated intraperitoneal chemotherapy perfusion (HIPEC) for peritoneal carcinomatosis can improve oncologic outcomes, but is associated with significant morbidity. Whether low-volume experience with CS/HIPEC results in acceptable outcomes is unknown. METHODS A retrospective review of all patients undergoing CS/HIPEC by a single surgeon. Experience was divided into first versus second 50 cases, and patient characteristics, operative details, and outcomes were compared. RESULTS Ninety patients underwent 100 CS/HIPEC procedures (mean age 57 years, 68% female). -Compared to the initial experience, the second 50 cases included more high grade tumors (68 vs. 52%) and greater disease burden (PCI 14.2 vs. 12.4). Operative times remained unchanged and mean blood loss decreased (978 vs. 684 ml). Hospital stay (mean 18.1 vs. 12.6 days), major complications (24 vs. 16%), and perioperative mortality (8 vs. 2%) declined. Overall median survival was 18 months and was longer with low grade tumors (26 vs. 16 months, P = 0.03). CONCLUSIONS Patients experienced reduced EBL, fewer major complications, and shorter hospital stay, despite having higher disease burden and higher grade tumors. This suggests that even low-volume experience with CS/HIPEC can lead to a trend in reduction of adverse perioperative events with acceptable oncologic outcomes.
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Affiliation(s)
- Swaroop R Bommareddi
- Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Vlad V Simianu
- Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Lisa V Mann
- Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Gary N Mann
- Department of Surgery, Division of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
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84
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Marrelli D, Polom K, de Manzoni G, Morgagni P, Baiocchi GL, Roviello F. Multimodal treatment of gastric cancer in the west: Where are we going? World J Gastroenterol 2015; 21:7954-7969. [PMID: 26185368 PMCID: PMC4499339 DOI: 10.3748/wjg.v21.i26.7954] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.
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85
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Braam HJ, Schellens JH, Boot H, van Sandick JW, Knibbe CA, Boerma D, van Ramshorst B. Selection of chemotherapy for hyperthermic intraperitoneal use in gastric cancer. Crit Rev Oncol Hematol 2015; 95:282-96. [PMID: 25921419 DOI: 10.1016/j.critrevonc.2015.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/22/2015] [Accepted: 04/07/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Several studies have shown the potential benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients. At present the most effective chemotherapeutic regime in HIPEC for gastric cancer is unknown. The aim of this review was to provide a comprehensive overview of chemotherapeutic agents used for HIPEC in gastric cancer. METHODS A literature search was conducted using the PubMed database to identify studies on chemotherapy used for HIPEC in gastric cancer patients. RESULTS AND CONCLUSION The chemotherapeutic regime of choice in HIPEC for gastric cancer has yet to be determined. The wide variety in studies and study parameters, such as chemotherapeutic agents, dosage, patient characteristics, temperature of perfusate, duration of perfusion, carrier solutions, intraperitoneal pressure and open or closed perfusion techniques, warrant more experimental and clinical studies to determine the optimal treatment schedule. A combination of drugs probably results in a more effective treatment.
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Affiliation(s)
- H J Braam
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - J H Schellens
- Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Science Faculty, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - H Boot
- Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J W van Sandick
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C A Knibbe
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands; Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - D Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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86
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Coccolini F, Catena F, Glehen O, Yonemura Y, Sugarbaker PH, Piso P, Montori G, Ansaloni L. Complete versus incomplete cytoreduction in peritoneal carcinosis from gastric cancer, with consideration to PCI cut-off. Systematic review and meta-analysis. Eur J Surg Oncol 2015; 41:911-9. [PMID: 25936764 DOI: 10.1016/j.ejso.2015.03.231] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The completeness of cytoreduction has been considerated as fundamental in increasing the life expectancy in patients with peritoneal carcinosis (PC) in gastric cancer. However no definitive data about the real effect of complete cytoreduction (CC) have still been published. Moreover the PCI cut-off to attempt CC with a reasonable risk-benefit ratio still lacks. MATERIAL AND METHODS A systematic review with meta-analysis of trials of complete vs incomplete cytoreduction in patients with peritoneal carcinosis from GC was performed. RESULTS Nine trials have been included (748 patients: 417 with CC0-CC1 and 324 with CC2-CC3 cytoreduction). 1, 2, 3 and 5 years survival is favorable to CC0-CC1 (Risk Ratio: 2.41, 8.18, 8.66, and 7.96 respectively). CC0 vs. CC1 survival benefit at 1 and 3 years: RR 2.28 and 6.36 respectively, favoring CC0. 1, 2, 3 and 5 years survival changes significantly above and below a PCI of 12. CONCLUSIONS 1, 2, 3 and 5-year overall survival is increased by CC0-CC1 cytoreduction in patients with PC from gastric origin. Moreover CC0 increases the 1 and 3 years survival when compared to CC1 cytoreduction.
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Affiliation(s)
- F Coccolini
- General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - F Catena
- General Surgery Dept., Ospedale Maggiore, Parma, Italy
| | - O Glehen
- General Surgery Dept., Centre Hospitalier Lyon Sud, Hospices Civils de Lyon and EMR 3738, Université Lyon 1, France
| | - Y Yonemura
- General Surgery Dept., Kusatsu General Hospital, Yabase 1660, Japan
| | | | - P Piso
- Surgery Dept., University of Regensburg, Regensburg D-93053, Germany
| | - G Montori
- General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - L Ansaloni
- General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy
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87
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Wu X, Li Z, Li Z, Jia Y, Shan F, Ji X, Bu Z, Zhang L, Wu A, Ji J. Hyperthermic intraperitoneal chemotherapy plus simultaneous versus staged cytoreductive surgery for gastric cancer with occult peritoneal metastasis. J Surg Oncol 2015; 111:840-7. [PMID: 25864884 DOI: 10.1002/jso.23889] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/02/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Our aim is to evaluate the safety and efficacy of two treatment strategies, hyperthermic intraperitoneal chemotherapy (HIPEC) plus simultaneous versus staged cytoreductive surgery (CRS) in patients with occult peritoneal metastasis of gastric cancer (GC). METHODS We retrospectively reviewed 26 GC patients who were potential curatively resectable by pre-operative evaluation and found occult peritoneal metastasis by diagnostic laparoscopy. Patients were treated by HIPEC plus either simultaneous CRS (CRS+HIPEC group, n = 11) or staged CRS after systematic chemotherapy (HIPEC+Chemo+CRS group, n = 15). RESULTS There is no mortality observed in both groups. The treatment complications in two group is comparable (P = 0.683), with 26.7% (4/15) in HIPEC+Chemo+CRS group, and 36.4% (4/11) in CRS+HIPEC group, respectively. The compliance of patients undergoing subsequent chemotherapy is higher in HIPEC+Chemo+CRS group (93.3%, 14/15) than that of CRS+HIPEC group (45.5%, 5/11) (P = 0.021). The mean interval time between CRS and first post-CRS systematic chemotherapy were 42.0 ± 12.0 days in HIPEC+Chemo+CRS group versus 69.8 ± 36.3 in CRS+HIPEC group (P = 0.163), respectively. The median OS in the HIPEC+Chemo+CRS group was 25.0 months, while 28.2 months in the CRS+HIPEC group (P = 0.738). CONCLUSION For resectable GC patients with laparoscopic findings of occult peritoneal metastasis, HIPEC plus staged CRS is with better tolerance and compliance than simultaneous CRS.
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Affiliation(s)
- Xiaojiang Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
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Khan M, Bhatti RP, Mukherjee S, Ali AM, Gilman AD, Mirrakhimov AE, Iroegbu N. A 26-year-old female with metastatic primary gastrointestinal malignancy presenting as menorrhagia. J Gastrointest Oncol 2015; 6:E21-5. [PMID: 25830046 DOI: 10.3978/j.issn.2078-6891.2014.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 11/14/2022] Open
Abstract
Krukenberg tumor is a metastatic malignant tumor of the ovary arising from a wide variety of primary sources, with the stomach being the most common. The presenting symptoms are non-specific and the primary source is often un-identified. Here, we describe a case of a 26-year-old Hispanic gravida 4, para 3 female who presented to our hospital with dysuria, pelvic pain and irregular, heavy menstrual cycles for three months duration. An endometrial biopsy was suggestive of carcinosarcoma. The patient underwent debulking surgery with partial cystectomy and bladder repair. A week later, she presented with hematemesis and an endoscopic biopsy revealed a diagnosis of poorly differentiated gastric adenocarcinoma. The tissue specimen obtained during the initial surgery was identified as Krukenberg tumor. The patient underwent adjuvant chemotherapy with FOLFOX along with gastrectomy with intraperitoneal chemotherapy.
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Affiliation(s)
- Maliha Khan
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
| | - Ravinder Pal Bhatti
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
| | - Sarbajit Mukherjee
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
| | - Alaa M Ali
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
| | - Alan D Gilman
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
| | - Aibek E Mirrakhimov
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
| | - Nkemakolam Iroegbu
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA
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Factors predicting peritoneal recurrence in advanced gastric cancer: implication for adjuvant intraperitoneal chemotherapy. Gastric Cancer 2015; 17:529-36. [PMID: 24101155 DOI: 10.1007/s10120-013-0306-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 09/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite adjuvant chemotherapy, patients with advanced gastric cancer (AGC) often develop recurrence, and the peritoneum is the most common site of recurrence. Therefore, intraperitoneal chemotherapy (IPC) has been proposed as a treatment option. The aim of this study was to select the eligible patients for application of IPC. METHODS A total of 805 patients with AGC who underwent curative D2 gastrectomy between May 2003 and December 2009 were included in this study. Risk factors for peritoneal recurrence were analyzed. RESULTS Recurrence developed in 245 patients (30.4 %). The first site of recurrence was the peritoneum in 144 patients (58.8 %), and the 5-year peritoneal recurrence-free survival was 79.3 %. Depth of tumor invasion ≥T3, extensive lymph node metastasis (N3), Bormann type 4, infiltrative type (Ming's classification), and venous invasion were independent risk factors for peritoneal recurrence. In subgroup analysis with patients who had received adjuvant chemotherapy (n = 481), depth of tumor invasion ≥T3, Bormann type 4, infiltrative type (Ming's classification), and venous invasion were independent risk factors for peritoneal recurrence. When a peritoneal recurrence risk index was made with each risk factor assigned 1 point (2 points for T4 stage), peritoneal recurrence rates with 0, 1, 2, 3, 4, or 5 points were 0 %, 3.9 %, 13.1 %, 33.3 %, 44.0 %, and 72.0 %, respectively, in those patients. CONCLUSIONS Patients at higher risk for peritoneal recurrence can be identified from the findings of this study. Further prospective studies are required to evaluate the usefulness of IPC for these patients.
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Di Vita M, Cappellani A, Piccolo G, Zanghì A, Cavallaro A, Bertola G, Bolognese A, Facchini G, D'Aniello C, Di Francia R, Cardì F, Berretta M. The role of HIPEC in the treatment of peritoneal carcinomatosis from gastric cancer: between lights and shadows. Anticancer Drugs 2015; 26:123-138. [PMID: 25406023 DOI: 10.1097/cad.0000000000000179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastric cancer is one of the most dreadful neoplastic diseases and remains the second cause of cancer death worldwide. Patients who develop peritoneal metastasis have a poor prognosis, with a median survival of less than 6 months. Despite being the cause of 60% of deaths from gastric cancer, peritoneal metastasis can still be considered a local disease and a local multidisciplinary approach can improve the prognosis even in this end-stage disease. At present, hyperthermic intraperitoneal chemotherapy (HIPEC) is the most widely accepted treatment for peritoneal surface diseases and can be performed in patients with different stages of cancer and with various antitumoral drugs. We performed a systematic review of the current status of HIPEC in the treatment of gastric peritoneal metastasis in an attempt to obtain answers to the questions that still remain: do results differ with these different methods? Does HIPEC exert a significant effect on the intracavitary delivery of drugs? Which patients should be treated and which should not? What can we expect from this approach in terms of survival, morbidity, and mortality? On reviewing the literature, despite the lack of trials comparing the different methods, we found that HIPEC has been shown to be an effective tool whenever a complete or an almost complete resection of the peritoneal implants can be performed. Therefore, it is advisable to refer all at-risk patients to specialized centers to be enrolled in randomized trials to achieve truly reliable results.
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Affiliation(s)
- Maria Di Vita
- aDepartment of Surgery, University of Catania, Catania Departments of bSurgery cMedical Oncology, National Cancer Institute, Aviano (PN) dDepartment of Surgery, 'La Sapienza' University Rome, Rome Departments of eUro-Gynecology fHaematology, National Cancer Institute, Fondazione 'G. Pascale', Naples gDivision of Medical Oncology, 'S.G. Moscati' Hospital, Taranto, Italy
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91
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Randle RW, Votanopoulos KI, Shen P, Levine EA, Stewart JH. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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92
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Graziosi L, Marino E, Donini A. Role of CRS plus HIPEC in gastric cancer peritoneal carcinomatosis. J Surg Oncol 2014; 111:248. [PMID: 25279726 DOI: 10.1002/jso.23789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/23/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Luigina Graziosi
- Department of General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Via Dottori, Perugia, Italy
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93
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Zhang XL, Shi HJ, Wang JP, Tang HS, Wu YB, Fang ZY, Cui SZ, Wang LT. MicroRNA-218 is upregulated in gastric cancer after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and increases chemosensitivity to cisplatin. World J Gastroenterol 2014; 20:11347-11355. [PMID: 25170221 PMCID: PMC4145775 DOI: 10.3748/wjg.v20.i32.11347] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/09/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the molecular mechanisms of miRNA in advanced gastric cancers (AGCs) before and after cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS: A miRNA microarray containing human mature and precursor miRNA sequences was used to compare expression profiles in serum samples of 5 patients with AGC before and after CRS + HIPEC. The upregulation of miR-218 was confirmed by real-time reverse transcription polymerase chain reaction and its expression was analyzed in SGC7901 gastric cancer cells.
RESULTS: miRNA microarray chip analysis found that the level of miR-218 expression was upregulated more than 8 fold after CRS + HIPEC. Furthermore, miR-218 increased gastric cancer cell chemosensitivity to cisplatin in vitro and inhibited gastric cell tumor growth in nude mice in vivo (0.5 vs 0.78, P < 0.05).
CONCLUSION: Our results indicated that targeting miR-218 may provide a strategy for blocking the development of gastric cancer and reverse the multi-drug resistance of gastric cell lines.
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94
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Bautista F, Elias D, Pasqualini C, Valteau-Couanet D, Brugières L. Hyperthermic intraperitoneal chemotherapy after cytoreductive surgery for the treatment of peritoneal carcinomatosis in pediatric solid malignancies: a single institution experience. J Pediatr Surg 2014; 49:1276-9. [PMID: 25092089 DOI: 10.1016/j.jpedsurg.2014.01.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis from abdominal tumors is an uncommon condition in children usually associated with dismal prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) following complete macroscopic surgery has been demonstrated to be safe and of benefit in selected cases. Experience in pediatrics is scarce. METHODS We retrospectively reviewed the medical files of patients under the age of 18years with an abdominal malignancy and peritoneal carcinomatosis who had been treated with HIPEC in our institution between March 2001 and April 2012. HIPEC had been administered using the open technique with oxaliplatin (300mg/m(2)) and irinotecan (200mg/m(2)) or oxaliplatin alone (460mg/m(2)) in the peritoneal cavity for 30minutes at 43°C and an intravenous perfusion of leucovorin (20mg/m(2)) and 5-fluorouracil (400mg/m(2)). RESULTS Nine patients had undergone HIPEC. Grade 3-4 complications had occurred in seven patients and were intraabdominal (n=3) or extraabdominal (n=8). No procedure-related deaths had occurred. Four patients are alive and in complete remission after a median follow-up of 4.9years (1.7-9.6). However one relapsed after HIPEC and required additional salvage therapy. CONCLUSIONS HIPEC could be considered in patients with peritoneal carcinomatosis from primary abdominal tumors. Its complications are manageable by an experienced multidisciplinary team. There are four long-term survivors, one after a relapse.
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Affiliation(s)
- Francisco Bautista
- Pediatric Oncology Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Dominique Elias
- Oncology Surgery Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Claudia Pasqualini
- Pediatric Oncology Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | | | - Laurence Brugières
- Pediatric Oncology Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
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95
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Liu Y, Endo Y, Fujita T, Ishibashi H, Nishioka T, Canbay E, Li Y, Ogura SI, Yonemura Y. Cytoreductive surgery under aminolevulinic acid-mediated photodynamic diagnosis plus hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from ovarian cancer and primary peritoneal carcinoma: results of a phase I trial. Ann Surg Oncol 2014; 21:4256-62. [PMID: 25056850 PMCID: PMC4218977 DOI: 10.1245/s10434-014-3901-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Indexed: 12/20/2022]
Abstract
Background We conducted a phase I clinical trial to evaluate the sensitivity, specificity, and safety of cytoreductive surgery (CRS) under aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD) plus hyperthermic intraperitoneal chemotherapy (HIPEC) on 20 patients with peritoneal carcinomatosis (PC) from ovarian cancer and primary peritoneal carcinoma (PPC). Patients and Methods Patients took 5-aminolevulinic acid (5-ALA) at a dose of 20 mg/kg orally with 50 mL of water 2 h before surgery. During surgery, the abdominal cavity was observed under blue light (wavelength of 440 nm) before and after CRS plus HIPEC. Specimens were excised and submitted for pathological examination to evaluate the specificity of ALA-PDD. Postoperative course was closely monitored and detailed information was recorded. Results CRS under ALA-PDD plus HIPEC was performed 21 times in 20 patients with PC (16 ovarian cancer, 4 PPC) between June 2011 and October 2013. With the exception of 1 (5 %) patient, strong red fluorescence was detected in 19 patients with ovarian cancer, with a sensitivity of 95 %. All specimens from red fluorescent lesions were invaded by cancer cells, with a specificity of 100 %. No severe adverse events occurred during the perioperative period, with the exception of some abnormal laboratory results and mild complications. All patients were alive until the last follow-up. Conclusion ALA-PDD provided a high sensitivity and specificity in detecting peritoneal metastasis in patients with PC from ovarian serous carcinoma and PPC. CRS under ALA-PDD plus HIPEC was a feasible and safe treatment option for patients with PC from ovarian cancer and PPC.
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Affiliation(s)
- Yang Liu
- NPO to Support Peritoneal Dissemination Treatment, 1-26 Haruki-Moto-Machi, Osaka, 596-0032, Japan
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96
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Rudloff U, Langan RC, Mullinax JE, Beane JD, Steinberg SM, Beresnev T, Webb CC, Walker M, Toomey MA, Schrump D, Pandalai P, Stojadinovic A, Avital I. Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol 2014; 110:275-84. [PMID: 25042700 DOI: 10.1002/jso.23633] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/05/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND A prospective randomized trial was conducted to compare the impact of systemic chemotherapy versus multi-modality therapy (complete cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and systemic chemotherapy) on overall survival (OS) in patients with gastric carcinomatosis. METHODS Patients with measurable metastatic gastric adenocarcinoma involving the peritoneum, and resectable to "no evidence of disease" were randomized to gastrectomy, metastasectomy, HIPEC, and systemic FOLFOXIRI (GYMS arm) or FOLFOXIRI alone (SA arm). RESULTS Seventeen patients were enrolled (16 evaluable); 7 of 9 patients in the multi-modality GYMS arm achieved complete cytoreduction (CCR0). Median OS was 11.3 months in the GYMS arm and 4.3 months in the SA arm. Four patients in the GYMS arm survived >12 months, 2 patients close to 2 years at last follow-up, and 1 patient more than 4 years, with 2 of these patients still alive. No patient in the SA arm lived beyond 11 months. All patients surviving beyond 12 months in the surgery arm achieved complete cytoreduction and had an initial Peritoneal Cancer Index (PCI) of ≤ 15. CONCLUSION Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival.
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Affiliation(s)
- Udo Rudloff
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Zeng WJ, Hu WQ, Wang LW, Yan SG, Li JD, Zhao HL, Peng CW, Yang GF, Li Y. Long term follow up and retrospective study on 533 gastric cancer cases. BMC Surg 2014; 14:29. [PMID: 24886548 PMCID: PMC4037426 DOI: 10.1186/1471-2482-14-29] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 05/08/2014] [Indexed: 12/18/2022] Open
Abstract
Background Gastric cancer (GC) is the third leading cause of cancer death in China and the outcome of GC patients is poor. The aim of the research is to study the prognostic factors of gastric cancer patients who had curative intent or palliative resection, completed clinical database and follow-up. Methods This retrospective study analyzed 533 GC patients from three tertiary referral teaching hospitals from January 2004 to December 2010 who had curative intent or palliative resection, complete clinical database and follow-up information. The GC-specific overall survival (OS) status was determined by the Kaplan-Meier method, and univariate analysis was conducted to identify possible factors for survival. Multivariate analysis using the Cox proportional hazard model and a forward regression procedure was conducted to define independent prognostic factors. Results By the last follow-up, the median follow-up time of 533 GC patients was 38.6 mo (range 6.9-100.9 mo), and the median GC-specific OS was 25.3 mo (95% CI: 23.1-27.4 mo). The estimated 1-, 2-, 3- and 5-year GC-specific OS rates were 78.4%, 61.4%, 53.3% and 48.4%, respectively. Univariate analysis identified the following prognostic factors: hospital, age, gender, cancer site, surgery type, resection type, other organ resection, HIPEC, LN status, tumor invasion, distant metastases, TNM stage, postoperative SAE, systemic chemotherapy and IP chemotherapy. In multivariate analysis, seven factors were identified as independent prognostic factors for long term survival, including resection type, HIPEC, LN status, tumor invasion, distant metastases, postoperative SAE and systemic chemotherapy. Conclusions Resection type, HIPEC, postoperative SAE and systemic chemotherapy are four independent prognostic factors that could be intervened for GC patients for improving survival.
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Affiliation(s)
| | | | | | | | - Jian-Ding Li
- Departments of Oncology & Pathology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan 430071, China.
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98
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Kitayama J. Intraperitoneal chemotherapy against peritoneal carcinomatosis: current status and future perspective. Surg Oncol 2014; 23:99-106. [PMID: 24721661 DOI: 10.1016/j.suronc.2014.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/13/2014] [Accepted: 03/18/2014] [Indexed: 02/08/2023]
Abstract
Peritoneal carcinomatosis (PC), caused by advanced abdominal malignancies, such as those of the ovarian and gastrointestinal tracts, has an extremely poor prognosis. Intraperitoneal (IP) chemotherapy has been clinically applied for several decades, but its clinical efficacy has not been fully determined. An accumulating body of evidence suggests that cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the optimal treatment for selected patients with ovarian and colorectal cancers with PC. Recent studies suggest that IP administration of taxane with systemic chemotherapy in a neoadjuvant setting improves patient survival in gastric cancer with PC. The pharmacokinetics of IP-administered drugs should be primarily considered in order to optimize IP chemotherapy. Therefore, the development of specific IP drugs using newly emerging molecular targeted reagents or new drug delivery systems, such as nanomedicine or controlled absorption/release methods, is essential to improve the efficacy of IP chemotherapy.
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Affiliation(s)
- Joji Kitayama
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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99
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Canbay E, Yonemura Y, Brucher B, Baik SH, Sugarbaker PH. Intraperitoneal chemotherapy and its evolving role in management of gastric cancer with peritoneal metastases. Chin J Cancer Res 2014; 26:1-3. [PMID: 24653620 DOI: 10.3978/j.issn.1000-9604.2014.02.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/12/2014] [Indexed: 12/29/2022] Open
Abstract
Advanced gastric cancer (GC) has been recognized as lethal disease when peritoneal metastases (PM) occurred. There is no standard treatment for advanced GC with PM. Until 1980s, the therapeutic arena for these patients had remained stagnant, with no therapeutic approach having shown a survival gain in GC with PM. However, cytoreductive surgery (CRS) with peritonectomy procedures and intraperitoneal chemotherapy (IPC) promising new combined therapeutic approach to achieve disease control for GC with PM. The recent publications changed the GC with PM treatment landscape by providing an evidence that CRS and IPC led to prolongation in overall survival (OS). This review will provide an overview of the evolving role of CRS and IPC in the management of advanced GC with PM in the current era.
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Affiliation(s)
- Emel Canbay
- 1 NPO HIPEC ISTANBUL, Akkavak Sokak No: 4/2 Nisantasi, Istanbul 34365, Turkey ; 2 Ethica Incirli Hospital, Bakirkoy, Istanbul 34144, Turkey ; 3 NPO to support Peritoneal Dissemination Treatment, 1-26, Harukimotomachi, Kishiwada City, Osaka 596-8522, Japan ; 4 Department of General Surgery, Kusatsu General Hospital, Yabase 1660, Kusatsu, Japan ; 5 Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan ; 6 Department of Peritoneal Surface Malignancy, Bon Secours Cancer Institute, Richmond VA 23226, USA ; 7 Deparment of General Surgery, Yonsei University College of Medicine, Seoul, South Korea ; 8 Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, NW, POB North Tower 3900 Washington, DC 20010, USA
| | - Yutaka Yonemura
- 1 NPO HIPEC ISTANBUL, Akkavak Sokak No: 4/2 Nisantasi, Istanbul 34365, Turkey ; 2 Ethica Incirli Hospital, Bakirkoy, Istanbul 34144, Turkey ; 3 NPO to support Peritoneal Dissemination Treatment, 1-26, Harukimotomachi, Kishiwada City, Osaka 596-8522, Japan ; 4 Department of General Surgery, Kusatsu General Hospital, Yabase 1660, Kusatsu, Japan ; 5 Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan ; 6 Department of Peritoneal Surface Malignancy, Bon Secours Cancer Institute, Richmond VA 23226, USA ; 7 Deparment of General Surgery, Yonsei University College of Medicine, Seoul, South Korea ; 8 Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, NW, POB North Tower 3900 Washington, DC 20010, USA
| | - Bjorn Brucher
- 1 NPO HIPEC ISTANBUL, Akkavak Sokak No: 4/2 Nisantasi, Istanbul 34365, Turkey ; 2 Ethica Incirli Hospital, Bakirkoy, Istanbul 34144, Turkey ; 3 NPO to support Peritoneal Dissemination Treatment, 1-26, Harukimotomachi, Kishiwada City, Osaka 596-8522, Japan ; 4 Department of General Surgery, Kusatsu General Hospital, Yabase 1660, Kusatsu, Japan ; 5 Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan ; 6 Department of Peritoneal Surface Malignancy, Bon Secours Cancer Institute, Richmond VA 23226, USA ; 7 Deparment of General Surgery, Yonsei University College of Medicine, Seoul, South Korea ; 8 Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, NW, POB North Tower 3900 Washington, DC 20010, USA
| | - Seung Hyuk Baik
- 1 NPO HIPEC ISTANBUL, Akkavak Sokak No: 4/2 Nisantasi, Istanbul 34365, Turkey ; 2 Ethica Incirli Hospital, Bakirkoy, Istanbul 34144, Turkey ; 3 NPO to support Peritoneal Dissemination Treatment, 1-26, Harukimotomachi, Kishiwada City, Osaka 596-8522, Japan ; 4 Department of General Surgery, Kusatsu General Hospital, Yabase 1660, Kusatsu, Japan ; 5 Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan ; 6 Department of Peritoneal Surface Malignancy, Bon Secours Cancer Institute, Richmond VA 23226, USA ; 7 Deparment of General Surgery, Yonsei University College of Medicine, Seoul, South Korea ; 8 Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, NW, POB North Tower 3900 Washington, DC 20010, USA
| | - Paul H Sugarbaker
- 1 NPO HIPEC ISTANBUL, Akkavak Sokak No: 4/2 Nisantasi, Istanbul 34365, Turkey ; 2 Ethica Incirli Hospital, Bakirkoy, Istanbul 34144, Turkey ; 3 NPO to support Peritoneal Dissemination Treatment, 1-26, Harukimotomachi, Kishiwada City, Osaka 596-8522, Japan ; 4 Department of General Surgery, Kusatsu General Hospital, Yabase 1660, Kusatsu, Japan ; 5 Department of General Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan ; 6 Department of Peritoneal Surface Malignancy, Bon Secours Cancer Institute, Richmond VA 23226, USA ; 7 Deparment of General Surgery, Yonsei University College of Medicine, Seoul, South Korea ; 8 Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center, NW, POB North Tower 3900 Washington, DC 20010, USA
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100
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Emoto S, Sunami E, Yamaguchi H, Ishihara S, Kitayama J, Watanabe T. Drug development for intraperitoneal chemotherapy against peritoneal carcinomatosis from gastrointestinal cancer. Surg Today 2014; 44:2209-20. [PMID: 24482110 DOI: 10.1007/s00595-014-0848-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/21/2013] [Indexed: 12/23/2022]
Abstract
Intraperitoneal (IP) chemotherapy for peritoneal carcinomatosis (PC) from gastrointestinal cancer has been investigated and applied clinically for several decades. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy have been considered to be the optimal treatment options for selected patients with colorectal and gastric cancers with PC. Accumulating evidence suggests that the administration of IP paclitaxel for patients with PC from gastric cancer may improve the patient survival. The pharmacokinetics of such treatment should be considered to optimize IP chemotherapy. In addition, newly emerging molecular-targeted therapies and research into new drug delivery systems, such as nanomedicine or controlled absorption/release methods, are essential to improve the effects of IP chemotherapy. This review summarizes the current status and future prospects of IP chemotherapy for the treatment of gastrointestinal cancer.
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Affiliation(s)
- Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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