Abstract
BackgroundThe association of preoperative systemic and intraperitoneal chemotherapy has been described in Eastern patients with very good outcomes in treatment responders. The aim of this paper is to describe the initial results of this multidisciplinary regimen in gastric cancer patients with very advanced peritoneal metastases.Case presentationWe present here the first four cases who received the treatment protocol. They had a baseline PCI between 19 and 33. Two patients had received systemic chemotherapy prior to this regimen. Three of them had significant response and were taken to cytoreductive surgery, while one patient who had 12 cycles of chemotherapy previously showed signs of disease progression and subsequently died. There was no significant postoperative morbidity, and three patients remain alive, two of them with no signs of recurrence.ConclusionSystemic and intraperitoneal chemotherapy led to a marked response in peritoneal disease extent in our initial experience and allowed three of four patients with very advanced disease to be treated with cytoreductive surgery.
Highlights
The association of preoperative systemic and intraperitoneal chemotherapy has been described in Eastern patients with very good outcomes in treatment responders
The aim of this study was to report the first four consecutive cases of gastric cancer patients who presented with advanced disease and disseminated peritoneal metastases and were treated with L-hyperthermic intraperitoneal chemotherapy (HIPEC) and bidirectional intraperitoneal and systemic chemotherapy (BISIC), followed by Cytoreductive surgery (CRS) + HIPEC
His recovery had no significant events, and he was discharged on the twelfth postoperative day. He underwent six cycles of chemotherapy (FOLFOX) in his home town and now is on follow-up, with no signs of recurrence. We report in this series the first four cases of gastric cancer patients with very advanced peritoneal disease who were treated with a multimodality regimen that included systemic and intraperitoneal chemotherapy in a recently nominated regimen known as BISIC [1], followed by cytoreductive surgery and HIPEC, in a single Western cancer center
Summary
The association of preoperative systemic and intraperitoneal chemotherapy has been described in Eastern patients with very good outcomes in treatment responders. Patients with advanced gastric cancer present with peritoneal metastases in about 30% of cases [1] and up to 50% of those treated with curative intent will develop relapse in the peritoneum. Standard treatment for these individuals is systemic chemotherapy, but median survival in this scenario is poor, around 3 to 6 months in most studies [2], reaching a little over 1 year in a recent Eastern trial [3]. Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer patients with peritoneal metastases has been associated. (L-HIPEC) and more effective systemic chemotherapy to this multidisciplinary treatment, labeled as bidirectional intraperitoneal and systemic chemotherapy (BISIC), has led to more significant response rates and improved survival in this set of patients [1].
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