Abstract
Background: Peritoneal metastasis (PM) develop in more than 50 % of gastric cancer (GC) patients. Median survival without treatment is not more than 3-7 months, and 8-12 months after modern combination chemotherapy. Innovative therapeutic approaches are urgently needed. Methods: Phase-2, open label prospective clinical trial assessing safety and efficacy of bidirectional chemotherapy for treating peritoneal metastasis of gastric cancer (PMGC). Treatment protocol included initial staging laparoscopy or laparotomy, 3-4 courses of systemic chemotherapy (XELOX) followed by Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) procedures every 6 weeks until progression of disease or death. Primary endpoints were overall survival and histological peritoneal regression grading score after rebiopsy. Results: 31 patients were included (9 men, 22 women, mean age 52 years), 24 with synchronous PM at diagnosis, 7 with metachronous PM after previous chemotherapy. Mean PCI was 13.8 (min-max 6-34). XELOX was administered in all patients and combined with 56 PIPAC procedures. Complete and partial pathological response was found in 60 % of the 15 patients eligible for tumor response assessment (4 and 5 patients, respectively). Median survival was 13 months. Conclusions: Bidirectional chemotherapy combining XELOX with PIPAC with cisplatin and doxororubicin is well tolerated, can induce objective tumor regression and is associated with a promising survival in PMGC.
Highlights
Gastric cancer (GC) is the fourth most common cancer and the second cause of cancer-related deaths in the Russian Federation [1]
All patients had peritoneal metastasis of gastric cancer (PMGC) proven by histology, verified in 20 patients by diagnostic laparoscopy, and in 11 by exploratory laparotomy performed in the referring hospital
Our study shows that Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) with intraperitoneal cisplatin and doxorubicin combined with palliative systemic chemotherapy with XELOX is active in patients with PMGC
Summary
Gastric cancer (GC) is the fourth most common cancer and the second cause of cancer-related deaths in the Russian Federation [1]. Risk factors for peritoneal metastasis in gastric cancer (PMGC) include invasion of serosa, lymph node metastases, presence of free cancer cells in peritoneal lavage, and diffuse type of cancer according to the Lauren classification [5, 6]. With a median survival of 3–5 months, PMGC has long been considered as Khomyakov et al.: Bidirectional chemotherapy in gastric cancer with peritoneal metastasis an end-stage disease without effective therapeutic options [6, 7]. Peritoneal metastasis (PM) develop in more than 50 % of gastric cancer (GC) patients. Methods: Phase-2, open label prospective clinical trial assessing safety and efficacy of bidirectional chemotherapy for treating peritoneal metastasis of gastric cancer (PMGC). Treatment protocol included initial staging laparoscopy or laparotomy, 3–4 courses of systemic chemotherapy (XELOX) followed by Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) procedures every 6 weeks until progression of disease or death. Primary endpoints were overall survival and histological peritoneal regression grading score after rebiopsy
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