Abstract
To investigate the efficacy and safety of intraperitoneal chemotherapy (IPC) for patients with gastric cancer and to compare effects between different regimens of IPC. Randomized controlled trials comparing the effects of surgery plus intraperitoneal chemotherapy with surgery alone or comparing the efficacy between different regimens of intraperitoneal chemotherapy were searched for in Medline, Embase, Pubmed, the Cochrane Library and the Chinese BioMedical Disc and so on by two independent reviewers. After quality assessment and data extraction, data were pooled for meta-analysis using RevMan5.16 software. Tests of interaction were used to test for differences of effects among subgroups grouped according to different IPC regimens. Fifteen RCTs with a total of 1713 patients with gastric cancer were included for quality assessment and data extraction. Ten studies were judged to be of fair quality and entered into meta-analysis. Hyperthermic intraoperative intraperitoneal chemotherapy (HR=0.60, P<0.01), hyperthermic intraoperative intraperitoneal chemotherapy plus postoperative intraperitoneal chemotherapy (HR=0.47, P<0.01) and normothermic intraoperative intraperitoneal chemotherapy (HR=0.70, P=0.01) were associated with a significant improvement in overall survival. Tests of interaction showed that hyperthermia and additional postoperative intraperitoneal chemotherapy did not impact on its effect. Further analysis revealed that intraperitoneal chemotherapy remarkably decrease the rate of postoperative hepatic metastasis by 73% (OR=0.27, 95% CI=0.12 to 0.67, P<0.01). However, intraperitoneal chemotherapy increased risks of marrow depression (OR=5.74, P<0.01), fever (OR=3.67, P=0.02) and intra-abdominal abscess (OR=3.57, P<0.01). The present meta-analysis demonstrates that hyperthermic intraoperative intraperitoneal chemotherapy and normothermic intraoperative intraperitoneal chemotherapy should be recommended to treat patients with gastric cancer because of improvement in overall survival. However, it is noteworthy that intraperitoneal chemotherapy can increase the risks of marrow depression, intra-abdominal abscesses, and fever.
Highlights
Gastric cancer is the fourth most common cancer in the world and currently is the second leading cause of cancerrelated death
The present meta-analysis demonstrates that hyperthermic intraoperative intraperitoneal chemotherapy and normothermic intraoperative intraperitoneal chemotherapy should be recommended to treat patients with gastric cancer because of improvement in overall survival
Based on randomized controlled trials(RCT) reporting efficacy of IPC for gastric cancer patients, intraperitoneal chemotherapy mainly can be summarized as the following five types: hyperthermic intraoperative intraperitoneal chemotherapy (HIIC), hyperthermic intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal chemotherapy (HIIC+PIC), normothermic intraoperative intraperitoneal chemotherapy (NIIC), normothermic postoperative intraperitoneal chemotherapy (NPIC) and hyperthermic
Summary
Gastric cancer is the fourth most common cancer in the world and currently is the second leading cause of cancerrelated death. Each year almost a million new cases of gastric cancer are reported worldwide (Ferlay et al, 2010). Radical surgery and intravenous chemotherapy have been widely used for gastric cancer, the long-term survival rate is still limited (five-year survival rate 55.3% (Paoletti et al, 2010)). Intraperitoneal chemotherapy (IPC) has been increasingly used to treat patients with gastric cancer due to the appealing theoretical rationales. Based on randomized controlled trials(RCT) reporting efficacy of IPC for gastric cancer patients, intraperitoneal chemotherapy mainly can be summarized as the following five types: hyperthermic intraoperative intraperitoneal chemotherapy (HIIC), hyperthermic intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal chemotherapy (HIIC+PIC), normothermic intraoperative intraperitoneal chemotherapy (NIIC), normothermic postoperative intraperitoneal chemotherapy (NPIC) and hyperthermic
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