Abstract
Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pa- thophysiology of peritoneal dissemination is still controversial, the rapid downhill course is uni- versal. Patients usually suffer abdominal distension, intestinal obstruction and various complica- tions before they succumb after a median of 3 - 6 months. Although not adopted in most interna- tional treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreduc- tive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical ben- efit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoad- juvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the ap- plication of translational science.
Highlights
Gastric cancer is the fifth most common malignancy in the world and almost one million new cases were estimated to have occurred in 2012
Palliative chemotherapy is recommended for patients with good performance status and adequate organ functions
Any form of Intraperitoneal Chemotherapy (IPC) was allowed for inclusion in the metaanalysis, twelve of the twenty studies utilized hyperthermic intraperitoneal chemotherapy (HIPEC) and cisplatin, mitomycin C and 5-FU were the commonly used chemotherapy
Summary
Gastric cancer is the fifth most common malignancy in the world and almost one million new cases were estimated to have occurred in 2012. About half of the cases occurred in Eastern Asia and a male-predominance was observed [1]. Peritoneal carcinomatosis (PC) is one of the most dismal manifestations of advanced gastric cancer. In more than 20% of patients, early peritoneal dissemination, in the form of either positive cytology or PC, was detected at presentation [2] and the likelihood increased with the extent of serosal invasion [3]. Patients with PC have a poor quality of life due to various complications including ascites and intestinal obstruction and have a universally grave prognosis. According to the multicenter prospective EVOCAPE I study, the median overall survival (OS) in gastric cancer patients with PC was 3.1 months substantially worse than the 5.2 months in colorectal cancer patients with PC [7]
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