Abstract
A phase II study to evaluate the efficacy and safety of a Bidirectional intraperitoneal and systemic induction chemotherapy (BISIC) were performed in patients with Peritoneal metastasis (PM) from gastric cancer in neoadjuvant setting. Sixty-one patients were treated with oral administration of S1 (60 mg/m 2 /day) for 14 consecutive days, followed by 7 days rest, plus intraperitoneal (i.p.) and intravascular (i.v.) administration of docetaxel and cisplatin (30 mg/m2 each) on day 1 and on day 8. The treatment course was repeated every 3 weeks for 3 times. Positive cytological results in 38 patients before BISIC became negative in 27 (71.1%) patients after BISIC. After BISIC, 44 patients received laparotomy and CRS, and complete cytoreduction was achieved in 28 of 44 patients (64%). During BISIC, side effects of grade 3 and 4 were found in 6 (9.9%) patients. After CRS, 7 (15.8%) and 3 (6.8%) patients developed Grade 3 and 4 complications. The overall operative mortality rate was 4.5% (2/44). Histologic effects on primary tumors were found in 87.9% (29/33 tumors). Complete histologic disappearance of PM was observed in 10 (22.7%) of 44 patients. Median survival time (MST) was 15.1 months, with a one and two-year survival of 62.4%, and 44.0%. BISIC therapy is safe and effective in gastric cancer patients with PM.
Highlights
The prognosis of gastric cancer patients with peritoneal metastases (PM) is extremely poor
47 patients with measurable target lesions were assessed for Overall response rate (ORR)
Diagnostic laparoscopy showed that complete ctroreduction was supposed to achieve only in fewer than 30% of gastric cancer-patients with PM who had not been treated with neoadjuvant chemotherapy [10]
Summary
The prognosis of gastric cancer patients with peritoneal metastases (PM) is extremely poor. Systemic chemotherapy or Cytoreductive surgery (CRS) alone does not improve the long-term survival of patients with PM. A new therapeutic approach based on the combination of Cytoreductive surgery (CRS) and Perioperative intraperitoneal chemotherapy (PIC) has been developed [2,3]. The macroscopic disease is completely removed by the peritonectomy techniques and the residual micrometastases are treated with Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC). Complete removal of primary tumor, regional lymph nodes and PM is essential for the long-term survival. Yonemura et al reported the results Neoadjuvant intraperitoneal/ systemic chemotherapy (NIPS), and patients with PM was treated by systemic chemotherapy of S-1 and intraperitoneal (i.p.) docetaxxel and cisplatin. After treatment by NIPS, the rate of complete cytoreduction increased, and allover survival after NIPS in combination with CRS was improved [5].
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