Abstract
We aimed to evaluate the effectiveness and safety of intravenous (IV) plus intraperitoneal (IP) chemotherapy compared to intravenous (IV) chemotherapy alone for patients with gastric cancer. Electronic databases were searched up to June 2013. Two authors independently selected studies, extracted data and assessed the quality of included studies. The GRADE System was adopted to rate the level of evidence. Of 392 citations, five RCTs involving 1072 patients were included. Overall, a significant improvement in in one- and three- and five-year survival rate was observed in the IV plus IP chemotherapy group (3 RCTs, n = 360, RR = 1.10, 95% CI 1.04 to1.17), (5 RCTs, n = 953, RR = 1.22, 95% CI 1.11 to1.35) and (3 RCTs, n = 347, RR = 1.42, 95% CI 1.12 to 1.80), respectively. Results supported a significant decrease in the rate of metastases (1 RCT, n = 85, RR = 0.41 95% CI 0.19 to 0.89) and peritoneal recurrence (2 RCTs, n = 297, RR = 0.41, 95% CI 0.26 to 0.62) in the IV plus IP chemotherapy group, however, the incidence of adverse events was increased. For patients with gastric cancer, IV plus IP chemotherapy can improve the overall survival rate and prevent the distant or peritoneal metastases. An increased risk of neutropenia, peripheral edema and neuropathy was observed.
Highlights
Gastric cancer is one of the most prevalent cancers worldwide and the second leading cause of cancer death[1,2]
The following agents were used in IV and IP chemotherapy: 5-FU, cisplatin, mitomycin-C, adriamycin and leucovorin
The rate of peripheral edema was examined by Yoon-Koo, and the results showed a significantly increased risk of developing peripheral edema when receiving IV combined with IP chemotherapy (RR = 3 .63, 95% CI 2.28 to 5.77, P = 0 .001)
Summary
Gastric cancer is one of the most prevalent cancers worldwide and the second leading cause of cancer death[1,2]. Surgery remains the major therapeutic approach for resectable gastric cancers. For patients with advanced gastric cancer and metastases, standard surgery plus IV chemotherapy is an option. Based on the results of a previous meta-analysis that compared IV chemotherapy plus surgery versus surgery alone for patients with gastric cancer, surgery plus IV chemotherapy was found to potentially benefit patients. Certain RCTs have compared IV plus IP chemotherapy versus IV chemotherapy alone after resection. Whether IP therapy should be added to IV chemotherapy after surgery has not been well explored. To determine if this combined chemotherapy is better than IV chemotherapy alone after curative resection, we collected the current evidence and included all relevant RCTs in this meta-analysis
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