Abstract
BackgroundDespite recent advances in systemic chemotherapy, the prognosis of patients with peritoneal metastases from gastric cancer still remains poor. Nonetheless, several efficacious intraperitoneal chemotherapy regimens have recently been developed for patients with peritoneal metastases. However, no study has investigated the effectiveness of intraperitoneal chemotherapy for metachronous peritoneal metastases from gastric cancer after curative surgery.Case presentationWe herein report a case of a 65-year-old man who had metachronous peritoneal metastases from gastric cancer after curative total gastrectomy who had been successfully treated with intraperitoneal chemotherapy. One month after surgery, adjuvant chemotherapy with S-1 was initiated given a final pathological stage of IIIB (pT4aN2M0). However, during adjuvant chemotherapy 12 months after surgery, tumor marker levels, which had been within normal range before surgery, increased with abdominal contrast-enhanced computed tomography (CT) revealing pelvic ascites. Thereafter, staging laparoscopy was performed, and the patient was diagnosed with peritoneal recurrence of gastric cancer. Following staging laparoscopy, an intraperitoneal access port was subcutaneously implanted for subsequent intraperitoneal chemotherapy. Combined chemotherapy with intraperitoneal and intravenous administration of paclitaxel and oral S-1 was then provided. After one course of combined chemotherapy, peritoneal lavage cytology was negative for malignancy. CT showed gradually decreasing ascites, whereas tumor marker levels returned to normal. The patient continued chemotherapy without major side effects and remained progression-free for 33 months with 36 chemotherapy cycles.ConclusionsA combination regimen including intraperitoneal chemotherapy could be a promising option for patients with peritoneal recurrence after gastric cancer surgery.
Highlights
Despite recent advances in systemic chemotherapy, the prognosis of patients with peritoneal metastases from gastric cancer still remains poor
A combination regimen including intraperitoneal chemotherapy could be a promising option for patients with peritoneal recurrence after gastric cancer surgery
When administered intra-abdominally, PTX is not absorbed through vessels but is alternatively slowly absorbed from the peritoneum through the lymphatic system, which results in prolonged drug retention in the peritoneal cavity [9,10,11]
Summary
Despite some progress in systemic chemotherapy [5,6,7,8], the median survival time (MST) of advanced/metastatic gastric cancer has still remained poor. Given that exclusive IP administration of PTX had insufficient effect against the primary tumor and metastatic lymph node, IP combined with systemic chemotherapy, which was effective against advanced gastric cancer with PM, had been developed. With this therapeutic approach, the median survival reached 17.6–22.5 months, whereas 1 year survival exceeded 70% [9]. The 3year overall survival rate was 21.9% (95% CI, 14.9 to 29.9%) in the IP arm and 6.0% (95% CI, 1.6 to 14.9%) in the SP arm These results suggested that the Phoenix regimen with IP PTX is a promising treatment option for patients having gastric cancer with PM.
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