Diagnosis Of Peritoneal Metastasis Research Articles

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

STAGING LAPAROSCOPY IS STILL A VALUABLE TOOL FOR OPTIMAL GASTRIC CANCER MANAGEMENT.

Complete surgical resection is the main determining factor in the survival of advanced gastric cancer patients, but is not indicated in metastatic disease. The peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect it. The aim of this study was to evaluate the role of staging laparoscopy in the staging of advanced gastric cancer patients in a Western tertiary cancer center. A total of 130 patients with gastric adenocarcinoma who underwent staging laparoscopy from 2009 to 2020 were evaluated from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of peritoneal metastasis and were also evaluated the accuracy and strength of agreement between computed tomography and staging laparoscopy in detecting peritoneal metastasis and the change in treatment strategy after the procedure. The peritoneal metastasis was identified in 66 (50.76%) patients. The sensitivity, specificity, and accuracy of computed tomography in detecting peritoneal metastasis were 51.5, 87.5, and 69.2%, respectively. According to the Kappa coefficient, the concordance between staging laparoscopy and computed tomography was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected peritoneal metastasis on computed tomography (p=0.007) were statistically correlated with peritoneal metastasis. In 40 (30.8%) patients, staging and treatment plans changed after staging laparoscopy (32 patients avoided unnecessary laparotomy, and 8 patients, who were previously considered stage IVb by computed tomography, were referred to surgical treatment). The staging laparoscopy demonstrated an important role in the diagnosis of peritoneal metastasis, even with current advances in imaging techniques.

\u03b2-Galactosidase is a target enzyme for detecting peritoneal metastasis of gastric cancer

Diagnosis of peritoneal metastasis in gastric cancer (GC) is essential for determining appropriate therapeutic strategies and avoiding non-essential laparotomy or gastrectomy. Recently, a variety of activatable fluorescence probes that can detect enzyme activities have been developed for cancer imaging. The aim of this study was to identify the key enzyme involved in peritoneal metastasis in GC. The enzymatic activity of gamma-glutamyl transpeptidase, dipeptidyl peptidase IV, and β-galactosidase (β-Gal) was assessed in lysates prepared from preserved human GC (n = 89) and normal peritoneal (NP; n = 20) samples. β-Gal activity was significantly higher in the human GC samples than in NP samples, whereas no differences were observed in the activities of the other enzymes. Therefore, we used SPiDER-βGal, a fluorescent probe that can be activated by β-Gal, for imaging GC cell lines, peritoneal metastasis in a mouse model, and fresh human resected GC samples (n = 13). All cell lines showed fluorescence after applying SPiDER-βGal, and metastatic nodules in the mice gradually developed high fluorescence that could be visualized with SPiDER-βGal. The human GC samples showed significantly higher fluorescence than NP samples. β-Gal is a useful target enzyme for fluorescence imaging of peritoneal metastasis in GC.

Detection of genes related to peritoneal metastasis of primary gastric cancer based on large-panel Next Generation Sequencing.

e16026 Background: Peritoneum is a common site of recurrence and metastasis of gastric cancer. The traditional clinical methods have poor sensitivity for the diagnosis of peritoneal metastasis, and there is no effective marker for predicting peritoneal metastasis of gastric cancer. In this study, the genetic profiles of primary tumors in gastric cancer patients with and without peritoneal metastasis, as well as the genetic alterations before and after metastasis in the same patient were analyzed to explore the genetic alterations associated with peritoneal metastasis. Methods: 232 patients with stage Ⅳ gastric cancer were divided into PM group and non-PM group according to whether there was peritoneal metastasis, DNA based Next Generation Sequencing (NGS) with a 1021 gene panel was performed on their samples. Clinical information was obtained synchronously from physicians and surgeons. Results: There was no significant difference in baseline clinical characteristics between patients in PM and non-PM groups. Molecular analysis revealed that in the PM group, the incidence of CDH1, CDH23, HDAC1, IDH1, KRAS, MED12, RHOA, NOTCH2, TGFBR1 mutations was significantly higher in PM group than that in non-PM group, and these mutated genes were mostly located in wnt/β- catenin and MAPK signaling pathway. On the contrary, the incidence of ERBB2 and CCNE1 amplification was significantly higher in non-PM group than in the other group. Further analysis of samples before and after peritoneal metastasis of 13 patients did not find significant differences in genetic alterations. Conclusions: Compared with other sites, the primary tumor of gastric cancer patients with peritoneal metastasis seems to have its unique molecular characteristics, and large-panel NGS can help us identify this part of patients. Future research may need to clarify whether more radical treatment strategies are needed for these patients.

A Nomogram Based on Clinicopathologic Features and Preoperative Hematology Parameters to Predict Occult Peritoneal Metastasis of Gastric Cancer: A Single-Center Retrospective Study.

Background In patients with gastric cancer (GC), peritoneal metastasis is an indication of the end stage and often indicates a poor outcome. The diagnosis of peritoneal metastasis, especially occult peritoneal metastasis (OPM), remains a challenge for surgeons. This study was designed to explore the relationship between OPM and clinicopathological characteristics and preoperative hematological parameters in patients with GC and to develop a nomogram to predict the probability of OPM before surgery. Methods A total of 672 patients with GC from our center were included, including 583 OPM-negative and 89 OPM-positive patients. These patients were divided into training and validation groups based on when they received treatment. OPM was diagnosed during surgery in patients without any signs of metastasis through imaging examination. Predictive factors were screened by least absolute shrinkage and selection operator logistic regression of all 18 characteristics. The nomogram of OPM was constructed based on these filtered variables. The discriminative and calibration performance of the model were simultaneously evaluated. Results A total of six variables, including tumor size, degree of differentiation, depth of invasion, Glasgow prognosis score, and plasma levels of CA125 and fibrinogen, were selected for integration into the final predictive nomogram. The area under curve (AUC) of the nomogram with six factors was 0.906 (95% confidence interval (CI): 0.872-0.941) and 0.889 (95% CI: 0.795-0.984) in the training and validation groups, respectively. Calibration plots of the nomogram in the two sets revealed a good consistency between predicted and actual probabilities. Decision curve analysis showed that the nomogram had a positive net benefit among all threshold probabilities between 0% and 82%. This nomogram was superior to models incorporating only clinicopathologic or hematologic features. Conclusion Both clinicopathological and preoperative hematological parameters are significantly associated with OPM. The nomogram constructed with six factors could be used to calculate the probability of OPM and identify the high-risk population in GC. This may be helpful for early detection of OPM in patients with GC.

Four-Point Computed Tomography Scores for Evaluation of Occult Peritoneal Metastasis in Patients with Gastric Cancer: A Region-to-Region Comparison with Staging Laparoscopy

BackgroundPreoperative diagnosis of peritoneal metastasis with gastric cancer remains challenging. This study explored the abnormal computed tomography (CT) signs of occult peritoneal metastasis (OPM) and evaluated it by region-to-region comparison using staging laparoscopy, from which a 4-point CT score system was developed.MethodsPatients with advanced gastric cancer (stage cT ≥ 2M0) diagnosed by CT were enrolled in the study. Occult peritoneal metastasis detected during staging laparoscopy was compared with preoperative CT to investigate the presence of abnormal signs by a region-to-region comparison. A 4-point CT score system was developed to define the radiologic characteristics. Subsequently, the diagnostic efficacy of the CT score system was prospectively verified.ResultsIn this study, 57 OPM regions were detected by staging laparoscopy in 33 of the 385 enrolled patients. The greater omentum was the most frequent site of OPM (38.60%, 22/57), which usually exhibited a smudge-like ground-glass opacity (S-GGO) (90.91%, 20/22) with a mean CT score of 2.14. The parietal and perihepatic peritoneum was the second most common site (22.81%, 13/57). A 4-point CT score system was developed based on the results. A cutoff CT score of 2 or higher was associated with a false-negative rate of 2% (2/99). This CT score system had a sensitivity of 87.5% and a specificity of 76.4% for an OPM-positive diagnosis (area under the curve, 0.848). The agreement between two radiologists on the assigned final score was 76.2% (kappa, 0.5).ConclusionsPatients with OPM mostly exhibited S-GGO on CT, which should be interpreted cautiously. The 4-point CT score system may improve the pretreatment evaluation of occult peritoneal metastasis, and staging laparoscopy might not be necessary for patients with a score lower than 2.

The ctDNA in peritoneal effusion of advanced gastric cancer for auxiliary diagnosis of peritoneal metastasis.

e15516 Background: Peritoneal metastasis (PM) is the most frequent mode of distant metastasis in advanced gastric cancer (GC). Most PM could cause peritoneal effusion. However, the cytological examination of cancer cells in peritoneal effusion is less sensitive to the identification of PM early; the specificity of serum biomarkers in peritoneal effusion is poor. It is necessary to assess the feasibility of peritoneal effusion circulating tumor DNA (ctDNA) for the PM diagnosis. Methods: 22 GCs with clinically confirmed PM as positive subjects and 11 non-cancers without PM as negative control were recruited. GC tissues were collected from 16 positive subjects. Peritoneal effusion supernatant (AS), peritoneal effusion cells (AC), and plasma were collected from each subject. Next generation sequencing (NGS) was performed using a 1021-gene panel. Sensitivity and specificity for the diagnosis of GC with PM were assessed. Results: Median age of 22 GCs with PM was 57 yrs. 12 patients were male. Diffused and mixed-type accounted for 73%. For 45% of patients, primary tumor was found in gastric body. In tissue samples, recurrent genes were TP53 (63%), CDH1 (50%), RHOA (19%), TGFBR1 (19%), KRAS (13%), and PIK3CA (13%). Private and tumor-derived mutations were found in the AS, AC, and plasma. 95% of (21/22), 82% (18/22), and 77% (17/22) of AS, AC, and plasma samples carried mutations, respectively. AS had more mutations than AC and plasma (Wilcoxon’s matched-pairs signed-ranked test, AS vs AC, p= 0.006; AS vs plasma, p = 0.013). 98% of the AC and 80% plasma mutations were contained in AS, Variant allele frequency (VAF) in AS was higher than others (Mann Whitney test, AS vs AC, p= 0.038; AS vs plasma, p< 0.001). In 22 GCs with PM, 3 were identified with no cancer cells in AS using cytological examination. Of these, 3 were detected with mutations in AS, one with mutations in AC. Mutations were detected in only one negative control AS and AC. Receiver operating characteristic (ROC) curve showed the number of mutations was related to PM (AS: AUC 0.93, 95% CI 0.82-1.00, p< 0.001; AC: AUC 0.85, 95% CI 0.70-1.00, p= 0.001). When the threshold was determined with one mutation, the sensitivity and specificity were 95% and 91% in AS, 82% and 91% in AC, respectively. Conclusions: Peritoneal effusion ctDNA contained tumor-derived and specific mutations. Peritoneal effusion ctDNA can be used for the auxiliary diagnosis of PM.

Comparison between multi-slice spiral CT and magnetic resonance imaging in the diagnosis of peritoneal metastasis in primary ovarian carcinoma.

The advent of disease evaluation by means of multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) represents a continually emerging role in the evaluation of various diseases; however, its role is yet to be adequately defined. Thus, the aim of the study was to compare the diagnostic value of MSCT and MRI in the diagnosis of peritoneal metastasis in primary ovarian carcinoma. Between January 2013 and December 2015, MSCT or MRI data were collected from 42 patients who had been previously diagnosed with peritoneal metastasis of ovarian carcinoma at the First Affiliated Hospital of Kunming Medical University. The tumor location, size, edge, and shape were all evaluated independently by three qualified imaging physicians using a double-blind method to confirm whether the patients were indeed suffering from peritoneal metastasis, as well as to rank the metastatic lesions recorded on a five-point scale. It was hypothesized that MRI and MSCT were comparable in the evaluation of ovarian carcinoma. Therefore, a receiver operating characteristics (ROC) curve was used to analyze the results and also to directly compare the respective diagnostic values of MSCT and MRI. In total, 165 metastatic lesions were confirmed by means of surgical operation. MSCT revealed 131 metastatic lesions, while MRI confirmed 154 metastatic lesions. The metastatic sites were primarily located on the subphrenic, epiploon, and gastrocolic ligaments and were further confirmed by either MRI or CT. In regard to MSCT, the most common site of underdiagnoses was in the vicinity of the uterus–rectum–fossa. MRI displayed a high detection rate in every site. The omission diagnostic rate of MSCT and MRI were 20.61% and 6.67%, respectively, while the accuracy rates were 79.39% and 93.33%, respectively. The obtained results revealed that the MSCT value of area under the ROC curve was smaller than that for MRI. Our findings provided evidence asserting that MRI, in comparison to MSCT, was more accurate in diagnosing peritoneal metastasis in patients with ovarian carcinoma.

Hyperthermic intraperitoneal chemoperfusion as a component of multimodality therapy for ovarian and primary peritoneal cancer.

The role of hyperthermic intraperitoneal chemoperfusion (HIPEC) in the multimodality treatment of ovarian peritoneal metastases (OPM) and primary peritoneal cancer (PPC) remains controversial. We hypothesized that cytoreductive surgery (CRS) and HIPEC would provide meaningful survival benefit without excessive morbidity. We reviewed clinicopathologic and perioperative data following 96 CRS-HIPEC procedures for primary or recurrent OPM and PPC. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes. CRS-HIPEC was mostly performed for recurrent disease (56.3%) and high-grade serous carcinoma (72.9%). Platinum-based systemic chemotherapy was administered to 89.5% of patients, with 75.5% having platinum-sensitive disease at CRS-HIPEC. Complete macroscopic resection was achieved in 70.8% of patients. Clavien-Dindo grade 3/4 morbidity occurred in 23.4% of patients; three patients died within 60-days postoperatively. Median overall survival from diagnosis of peritoneal metastases and CRS-HIPEC was 78 and 38 months, respectively. Completeness of cytoreduction, pathologic subtype, and 30-day morbidity were independent predictors of survival in multiple regression analysis. Our study demonstrates promising survival data and supports the role of HIPEC in the multimodality treatment algorithm for primary or recurrent OPM and PPC. However definite indications and timing of HIPEC need to be clarified by prospective studies.

Survival and Prognostic Factors for Metachronous Peritoneal Metastasis in Patients with Colon Cancer.

The clinical course of metachronous peritoneal metastasis of colorectal origin is poorly understood. In this retrospective study, we aimed to elucidate survival and prognostic factors for metachronous peritoneal metastasis. Patients with metachronous peritoneal metastasis after curative resection for stage I-III colon cancer were retrospectively reviewed, and the incidence and prognosis of metachronous peritoneal metastasis were investigated. Prognostic factors were identified by univariate and multivariate analyses. Among 1582 surgically resected stage I-III colon cancer patients, 65 developed metachronous peritoneal metastasis. The 5-year cumulative incidence rate was 4.5%, and the median survival after diagnosis of peritoneal metastasis was 29.6months. None of the patients underwent peritonectomy or intraperitoneal chemotherapy. Independent prognostic factors included right colon cancer [hazard ratio (HR) 2.69, 95% confidence interval (CI) 1.26-5.64; p=0.011], time to metachronous peritoneal metastasis of <1year (HR 2.02, 95% CI 1.04-3.87; p=0.040), Peritoneal Cancer Index (PCI) >10 (HR 3.68, 95% CI 1.37-8.99; p=0.012), concurrent metastases (HR 4.09, 95% CI 2.02-8.23; p<0.001), and peritoneal nodule resection (HR 0.31, 95% CI 0.13-0.65; p=0.002). A proportion of colon cancer patients with metachronous peritoneal metastasis may benefit from combined peritoneal nodule resection and systemic chemotherapy. Right colon cancer, early peritoneal metastasis, a high PCI, and concurrent metastases negatively affected prognosis in patients with metachronous peritoneal metastasis.

Clinical Significance of CA125 Level with Clinicopathological Variables and Peritoneal Dissemination in Patients with Gastric Carcinoma

Background: Serum tumor markers have been shown to correlate with the clinical status of patients with advanced gastric cancer. However, the clinical significance of tumor marker in patients with peritoneal dissemination has not been fully verified. Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of tumor marker CA125 level in gastric cancer & diagnosis of peritoneal metastasis in gastric cancer. Objective: This study is an evaluation of serum levels in the tumor markers CA125 in gastric cancer patients in preoperative periods to determine the Relationship of preoperative CA125 level with clinicopathological variables & to predict association of CA125 level with peritoneal dissemination in gastric carcinoma. Methods: A prospective cross sectional study was done of 61 patients diagnosed with gastric cancer treated at a single institution in Bangladesh National Institute of Cancer Research and Hospital, Mohakhali, Dhaka, Bangladesh from July 2010 - December 2011. Analyses were performed to identify patient and tumor-related characteristics and to identify peritoneal metastasis. The sera from 61patients with gastric cancer were measured for CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) or ultrasound (US) before laparotomy. Peritoneal involvement was confirmed by either ascites diagnosed by USG or CT, direct visualization of metastatic deposits during surgery and detection of cancer cell by peritoneal wash fluid taken after laparotomy. Results: The serum levels of CA125 the cutoff value of 35 U/ml was regarded as positive. Preoperative levels of CA125 were above the cut-off levels in 23% of all cases. A total of 30(49.2%) patients were showed peritoneal involvement. The CA125 level was significantly correlated with the degree of peritoneal dissemination and the existence of malignant ascites. In particular, the serum CA125 levels showed sensitivity 73%, specificity 86%, and the highest odd ratio (18.33 95% CI) for predicting peritoneal metastasis. The positive and negative predictive values of CA125 were 65% and 91%, respectively. So in this study preoperative serum CA125 levels may provide a value in determining depth of invasion, lymph node involvement & metastasis in patients with gastric cancer. CA125 was very sensitive in detecting peritoneal dissemination in gastric carcinoma patients. Conclusion: In this study Preoperative serum Measurement of the serum CA125 titer may be a powerful predictor of peritoneal metastases in patients with gastric carcinoma& may provide a value in determining depth of invasion, lymph node involvement & metastasis in patients with gastric cancer.

The clinical trial for photodynamic diagnosis mediated 5-ALA for peritoneal metastasis due to advanced gastric cancer.

71 Background: In advanced gastric cancer, the diagnosis of peritoneal metastasis is mandatory prior to the decision of therapy, therefore staging laparoscopy (SL) has gained wider clinical acceptance. However, a false-negative rate of 10% using SL has also been reported, which demonstrates the limitation of optical observation for the dissemination of the cancer nest. Photodynamic diagnosis (PDD) by 5-aminolevulinic acid (ALA) has been proposed for peritoneal metastasis in SL and showed higher sensitivity than that of conventional examination. To evaluate effectiveness and safety of ALA-PDD for the diagnosis of the peritoneal disseminations. Methods: Thirteen advanced gastric cancer that had the signs of peritoneal metastasis pointed out by CT scan prior to the treatment were included. Patients were administered 5-ALA (1g/body) orally 4hours prior to the SL. Several lesions regulated to observe bilateral sub- phrenic peritoneum, bilateral flanks and Douglas’s pouch (conventional examination, PDD each). If the nodules suspected for the metastatic lesion were found, they were diagnosed by laparoscopic biopsy. We evaluate the potential of additional detection rate compared to the conventional examination and safety. Results: The patients characters were as below, gender (male: female) = 8:5, Age (median; range) = 69 years old (39-76). The TNM factor were that cT3:4a = 2:11, cN0:1:2:3 = 2:0:7:4, cM0:1 = 10:3(Japanese classification of gastric carcinoma: 3rd English edition).The additional detection rate was 8.3 %( 1/13) and the incidence of adverse effect was 8.3 %( nausea, Grade 1). Conclusions: The ALA-PDD was effective and safe examination for the peritoneal metastasis of gastric cancer. And furthermore, we are now going to conduct the new investigator initiated trial.

Theoretical Considerations for Optimal Cytoreductive Surgery Plus Hyperthermic Perioperative Chemotherapy

Background: The concepts regarding the definitive management of peritoneal metastases seems straightforward in that surgery is to remove all visible disease and then intraperitoneal chemotherapy is used to eradicate minimal residual disease. However, implementation of this management strategy presents numerous patient-related, methodologic, and pharmacologic variables. Methods: In order to optimize cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC), important theoretical considerations for implementation of this management strategy are presented. The aim of the study is to integrate these modifications in the treatment of abdominal and pelvic malignancy into practice and thereby improve outcomes. Results: Surgical technology to achieve a complete response is necessary but not sufficient to optimally pursue a curative treatment option. Strategies to initiate treatments with the lowest possible peritoneal cancer index (PCI) involve proactive treatments of the primary gastrointestinal cancer, neoadjuvant chemotherapy, initiation of treatments at the first diagnosis of peritoneal metastases, and the use of laparoscopy and radiology to select patients. Tumor cell entrapment should be avoided. Mechanical removal of cancer cells by vigorous irrigation techniques carries minimal risk and may reduce residual disease. Chemotherapy agents that cause a response, result in prolonged intraperitoneal drug retention and show a high peritoneal to plasma concentration ratio are recommended. Finally, long-term bidirectional adjuvant normothermic chemotherapy (BANC) has been shown in randomized trials in ovarian cancer to improve survival and may be of value in other diseases. Conclusions: Despite the complexity of patient management using CRS and HIPEC, application of six basic principles promise to contribute to the results of treatment of peritoneal metastases.

18F-FDG PET/CT Outperforms Contrast Enhanced CT in the Diagnosis of Peritoneal Metastases from Ovarian Tumors

18F-FDG PET/CT Outperforms Contrast Enhanced CT in the Diagnosis of Peritoneal Metastases from Ovarian Tumors

Clinical significance of the uPA system in gastric cancer with peritoneal metastasis

BackgroundIt has been demonstrated that urokinase-type plasminogen activator (uPA) is involved in tumor cell metastasis by degrading the extracellular matrix. However, there is little direct evidence of clinical uPA system expression in peritoneal metastatic tissues of gastric cancer. The objective of this study was to investigate uPA system expression in peritoneal tissues of peritoneal and nonperitoneal metastasis patients, and to explore the diagnostic value of the uPA system.MethodsExpressions of uPA, uPAR, and PAI-1 were measured by semi-quantitative RT-PCR and ELISA. uPA activity was detected using a uPA activity kit.ResultsThere was no significant difference in uPA, uPAR, and PAI-1 expression in two types of peritoneal tissue in seven patients with peritoneal metastasis. However, uPA, uPAR, and PAI-1 expressions in peritoneal metastatic lesions were significantly higher than those in normal peritoneal tissues of 24 nonperitoneal metastasis patients (P <0.05). Moreover, no statistical discrepancy of uPA activity was observed in various different tissues.ConclusionsThe expression of the uPA system positively correlates with peritoneal metastasis of gastric cancer. This expression difference in peritoneal or nonperitoneal metastasis patients may provide a reference for diagnosis of peritoneal metastasis.

Diagnosis of Peritoneal Metastases with Abdominal Malignancies: Role of ADC Measurement on Diffusion Weighted MRI.

The purpose of our study was to evaluate the utility of the apparent diffusion coefficient (ADC) value measurement in the diagnosis of peritoneal metastases on diffusion weighted magnetic resonance imaging. Diffusion weighted imaging with conventional magnetic resonance imaging sequences was performed on twenty consecutive oncology patients (group I) with peritoneal metastases. The ADC values of the metastases, the peritoneal fat around the metastases (group I) and the peritoneal fat in patients with no malignancy (group II) at b(0-100), b(0-600), and (b 0-1000) s/mm(2) gradients were measured and compared. The apparent diffusion coefficient values of three gradients in peritoneal metastases (2.27±0.4; 1.67±0.7 and 1.09±0.4×10(-3) mm(2)/s at b 100, 600 and 1000 gradients, respectively) were significantly lower than the ADC values of the peritoneal fat around metastases (3.07±0.4; 2.07±0.4; 1.33±0.3×10(-3) mm(2)/s at b 100, 600 and 1000 gradients, respectively) (p<0.05). There was no significant difference between the ADC values of peritoneal fat in the patients of group I and group II at the 3 diffusion gradients (p>0.05). The measurement of ADC values may be used as a complementary diagnostic method in differentiating peritoneal metastases from peritoneal fat on Diffusion Weighted MRI (DWMRI DWMRI).

Diagnosis and treatment of peritoneal metastasis of gastric cancer

The peritoneum is one of the most common sites of gastric cancer recurrence or metastasis.Peritoneal metastasis seriously affects the patients life quality and shortens patients survival time,so early diagnosis and active treatment have a major impact on the prognosis. Continuous studies of some biomarkers and extensive using of ncw imaging technology make the early diagnosis of peritoneal metastasis more promising.Simultaneously,with the rapid development of intraperitoneal chemotherapy and molecular targeted therapy,there are more options in the treatment. Key words: Stomach neoplasms; Neoplasm seeding; Diagnosis; Therapeutic uses

Preoperative manometry is not a predictor of postoperative dysphagia in chagasic achalasia

We report a case of gastric cancer with peritoneal recurrence that responded to chemotherapy with paclitaxel and TS-1. A 62-year-old woman, who underwent total gastrectomy for advanced gastric cancer 2 years and 6 months ago, was admitted to our hospital with a chief complaint of abdominal distention and intestinal obstruction due to a large amount of ascites. Cytology of ascites revealed peritoneal dissemination, and chemotherapy with bi-weekly paclitaxel (90 mg/body) was begun. Clinical symptoms, including ascites and intestinal obstruction, were improved only after the second administration of paclitaxel. As she was able to take food orally, she was placed on combined chemotherapy consisting of tri-weekly paclitaxel (9 0 mg/body-120 mg/body: day 1) and TS-1 (80 mg/day: day 1-14) and 1 or 2 weeks rest. The patient had no signs or symptoms of peritoneal metastasis or toxicity except for general fatigue and watery eyes 1 year and 8 months after the diagnosis of peritoneal metastasis. Paclitaxel and TS-1 therapy was thought to be an effective chemotherapy against recurrent gastric cancer with peritoneal dissemination.