Journal Article

Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer

Ishibashi, Haruaki, Yonemura, Yutaka, Ichinose, Masumi, Li, Yan, Takao, Nobuyuki, Mizumoto, Akiyoshi, Liu, Yang, Hirano, Masamitu, Noguchi, Kousuke, Takeshita, Kazuyosi

2017

Overview

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.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Chemotherapy, Adjuvant / Chemotherapy, Cancer, Regional Perfusion - mortality / Combined Modality Therapy / Cytoreduction Surgical Procedures / Follow-Up Studies / Gastrointestinal Oncology / Humans / Hyperthermia, Induced - mortality / Laparoscopy - mortality / Lymphatic Metastasis / Medicine / Medicine & Public Health / Neoadjuvant Therapy - mortality / Oncology / Peritoneal Neoplasms - secondary / Peritoneal Neoplasms - therapy / Prognosis / Stomach Neoplasms - pathology / Stomach Neoplasms - therapy / Surgery / Surgical Oncology / Survival Rate