[Peritoneal Carcinomatosis of Gastric Cancer : Treatment Options for Peritoneal Carcinomatosis of Gastric Cancer]

Overview

Journal Chirurgie (Heidelb)

Specialty General Surgery

Date 2022 Aug 18

PMID 35980425

Authors

Eva M Dobrindt

Safak Gul-Klein

Miguel Enrique Alberto Vilchez

Felix Gronau

Peter Thuss-Patience

Beate Rau

Affiliations

Soon will be listed here.

Abstract

Background: Gastric cancer is one of the most aggressive malignant diseases of the gastrointestinal tract with a high rate of metastasis. Peritoneal metastasis occurs in up to 60% of all patients and synchronously in up to 30% in locally advanced gastric cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been an established treatment option in selected patients for several years, as the HIPEC serves as an alternative administration route.

Objective: This article presents a schematic display of the various treatment options depending on the extent of peritoneal carcinomatosis in a gastric cancer.

Methods: A literature search and analysis of the current literature on the treatment of gastric cancer with peritoneal metastases were carried out. A differentiation was made between limited and extensive peritoneal carcinomatosis together with the appropriate treatment strategy.

Results: Principally, individual systemic chemotherapy is the backbone of treatment of gastric cancer with peritoneal metastases. In selected patients and in cases of limited peritoneal carcinomatosis, CRS and HIPEC can be conducted and survival is improved; however, CRS is still contraindicated in cases of extensive peritoneal carcinomatosis and in exceptional cases pressurized intraperitoneal aerosol chemotherapy (PIPAC) can be carried out.

Conclusion: In selected patients CRS and HIPEC can lead to an improvement with respect to overall and disease-free survival. In cases of extensive peritoneal carcinomatosis, individualized chemotherapy remains the major treatment option.

References

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Khan H, Johnston F . Current role for cytoreduction and HIPEC for gastric cancer with peritoneal disease. J Surg Oncol. 2022; 125(7):1176-1182. PMC: 9322542. DOI: 10.1002/jso.26894. View

Seshadri R, Glehen O . Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer. World J Gastroenterol. 2016; 22(3):1114-30. PMC: 4716024. DOI: 10.3748/wjg.v22.i3.1114. View

Desiderio J, Chao J, Melstrom L, Warner S, Tozzi F, Fong Y . The 30-year experience-A meta-analysis of randomised and high-quality non-randomised studies of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer. Eur J Cancer. 2017; 79:1-14. PMC: 5568419. DOI: 10.1016/j.ejca.2017.03.030. View

Valletti M, Eshmuminov D, Gnecco N, Gutschow C, Schneider P, Lehmann K . Gastric cancer with positive peritoneal cytology: survival benefit after induction chemotherapy and conversion to negative peritoneal cytology. World J Surg Oncol. 2021; 19(1):245. PMC: 8371873. DOI: 10.1186/s12957-021-02351-x. View

Okines A, Norman A, McCloud P, Kang Y, Cunningham D . Meta-analysis of the REAL-2 and ML17032 trials: evaluating capecitabine-based combination chemotherapy and infused 5-fluorouracil-based combination chemotherapy for the treatment of advanced oesophago-gastric cancer. Ann Oncol. 2009; 20(9):1529-1534. DOI: 10.1093/annonc/mdp047. View

Bang Y, Van Cutsem E, Feyereislova A, Chung H, Shen L, Sawaki A . Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010; 376(9742):687-97. DOI: 10.1016/S0140-6736(10)61121-X. View

Janjigian Y, Shitara K, Moehler M, Garrido M, Salman P, Shen L . First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet. 2021; 398(10294):27-40. PMC: 8436782. DOI: 10.1016/S0140-6736(21)00797-2. View

Jacquet P, Sugarbaker P . Peritoneal-plasma barrier. Cancer Treat Res. 1996; 82:53-63. DOI: 10.1007/978-1-4613-1247-5_4. View

10.

Yonemura Y, Canbay E, Li Y, Coccolini F, Glehen O, Sugarbaker P . A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent. Eur J Surg Oncol. 2016; 42(8):1123-31. DOI: 10.1016/j.ejso.2016.03.016. View

11.

Randle R, Swett K, Swords D, Shen P, Stewart J, Levine E . Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites. Ann Surg Oncol. 2013; 21(5):1474-9. PMC: 4090137. DOI: 10.1245/s10434-013-3224-y. View

12.

Yarema R, Mielko J, Fetsych T, ohorchak M, Skorzewska M, Rawicz-Pruszynski K . Hyperthermic intraperitoneal chemotherapy (HIPEC) in combined treatment of locally advanced and intraperitonealy disseminated gastric cancer: A retrospective cooperative Central-Eastern European study. Cancer Med. 2019; 8(6):2877-2885. PMC: 6558472. DOI: 10.1002/cam4.2204. View

13.

Facchiano E, Risio D, Kianmanesh R, Msika S . Laparoscopic hyperthermic intraperitoneal chemotherapy: indications, aims, and results: a systematic review of the literature. Ann Surg Oncol. 2012; 19(9):2946-50. DOI: 10.1245/s10434-012-2360-0. View

14.

Nadiradze G, Giger-Pabst U, Zieren J, Strumberg D, Solass W, Reymond M . Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with Low-Dose Cisplatin and Doxorubicin in Gastric Peritoneal Metastasis. J Gastrointest Surg. 2015; 20(2):367-73. PMC: 4722080. DOI: 10.1007/s11605-015-2995-9. View

15.

Di Giorgio A, Schena C, Attalla El Halabieh M, Abatini C, Vita E, Strippoli A . Systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC): A bidirectional approach for gastric cancer peritoneal metastasis. Surg Oncol. 2020; 34:270-275. DOI: 10.1016/j.suronc.2020.05.006. View

16.

Gronau F, Feldbruegge L, Oberwittler F, Gonzalez-Moreno S, Villeneuve L, Eveno C . HIPEC in Peritoneal Metastasis of Gastric Origin: A Systematic Review of Regimens and Techniques. J Clin Med. 2022; 11(5). PMC: 8911234. DOI: 10.3390/jcm11051456. View

17.

Glehen O, Gilly F, Arvieux C, Cotte E, Boutitie F, Mansvelt B . Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010; 17(9):2370-7. DOI: 10.1245/s10434-010-1039-7. View

18.

Bonnot P, Piessen G, Kepenekian V, Decullier E, Pocard M, Meunier B . Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer With Peritoneal Metastases (CYTO-CHIP study): A Propensity Score Analysis. J Clin Oncol. 2019; 37(23):2028-2040. DOI: 10.1200/JCO.18.01688. View

19.

Hotopp T . HIPEC and CRS in peritoneal metastatic gastric cancer - who really benefits?. Surg Oncol. 2019; 28:159-166. DOI: 10.1016/j.suronc.2019.01.005. View

20.

Yang X, Huang C, Suo T, Mei L, Yang G, Cheng F . Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011; 18(6):1575-81. PMC: 3087875. DOI: 10.1245/s10434-011-1631-5. View