Abstract
The management of peritoneal metastases from gastric cancer origin has evolved considerably over the last three decades with the establishment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as efficacious therapies in carefully selected patients. Other approaches such as the use of prophylactic/adjuvant HIPEC in patients who are considered high-risk and those with positive peritoneal cytology will benefit from additional data before being adopted into routine clinical practice. Lastly, there are new and emerging intraperitoneal chemotherapy techniques such as early post-operative intraperitoneal chemotherapy (EPIC) for residual microscopic disease, and pressurized intraperitoneal aerosolized chemotherapy (PIPAC) for patients with advanced unresectable peritoneal carcinomatosis, which are currently under evaluation in clinical trials. The following review outlines the natural history of gastric cancer, currently available neoadjuvant and adjuvant therapies for resectable disease, and existing evidence supporting various approaches to CRS and intraperitoneal chemotherapy.
Highlights
Current studies demonstrate that there is an emerging role for the use of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) to prevent the incidence of peritoneal metastases for high-risk patients with gastric cancer
Identification of patients with gastric cancer at high risk of developing peritoneal metastasis, standardization of the drugs and their dosage, and robust results from ongoing trials will ensure its inclusion in the treatment armamentarium for resectable gastric cancer
For patients with established peritoneal carcinomatosis, current approaches for intraperitoneal chemotherapy include the use of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), as curative-intent in both cytology-positive and macroscopic disease, and as early post-operative intraperitoneal chemotherapy (EPIC) in the setting of microscopic residual disease
Summary
Gastric cancer is the fifth most common cancer in the United States with an estimated. In the United States, approximately 28% of patients present with localized disease for whom the mainstay of treatment remains curative-intent gastrectomy with extended (D2) lymphadenectomy [3]. Even after resection and extended lymphadenectomy, studies of recurrence patterns demonstrate that gastric cancer has the highest rate of peritoneal recurrence of all digestive cancers, with a rate approaching 40%–60% after curative gastrectomy, rising to 80% for those. The survival rate for gastric carcinoma patients with peritoneal carcinomatosis has been poor, ranging from 2.2 to 8.8 months and no survival at 5 years [13]. As peritoneal carcinomatosis is considered a variant of the systemic spread of disease, the standard recommendation for patients with gastric cancer metastatic to the peritoneum is systemic chemotherapy or best supportive care [16]. The purpose of this review is to analyze the existing body of literature regarding multimodal treatment strategies for prevention and treatment of peritoneal carcinomatosis from gastric cancer
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