Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility?

• Published in: Annals of surgical oncology Vol. 23; no. 6; pp. 1971 - 1979
• Main Authors: Chia, C. S., You, B., Decullier, E., Vaudoyer, D., Lorimier, G., Abboud, K., Bereder, J.-M., Arvieux, C., Boschetti, G., Glehen, O.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2016; Springer Nature B.V
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma - pathology; Carcinoma - therapy; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Cytoreduction Surgical Procedures; Female; Follow-Up Studies; Gastrointestinal Oncology; Humans; Hyperthermia, Induced; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Prognosis; Stomach Neoplasms - pathology; Stomach Neoplasms - therapy; Surgery; Surgical Oncology; Survival Rate; Young Adult; Gastric Cancer; Intraperitoneal Chemotherapy; Signet Ring Cell; Overall Survival; Peritoneal Carcinomatosis
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-5081-3

Background
Peritoneal carcinomatosis is an increasingly common finding in gastric carcinoma. Previously, patients were treated as terminal, and median survival was poor. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this context is still highly debatable.
Objective
The aim of this study was to evaluate the long-term outcomes associated with CRS and HIPEC, and define prognostic factors for cure, if possible.
Patients and Methods
All patients with gastric carcinomatosis from five French institutions who underwent combined complete CRS and HIPEC and had a minimum follow-up of 5 years were included in this study. Cure was defined as a disease-free interval of more than 5 years from the last treatment until the last follow-up.
Results
Of the 81 patients who underwent CRS and HIPEC from 1989 to 2009, 59 had a completeness of cytoreduction score (CCS) of 0 (complete macroscopic resection), and the median Peritoneal Cancer Index (PCI) score was 6. Mitomycin C was the most commonly used drug during HIPEC (88 %). The 5-year overall survival (OS) rate was 18 %, with nine patients still disease-free at 5 years, for a cure rate of 11 %. All ‘cured’ patients had a PCI score below 7 and a CCS of 0. Factors associated with improved OS on multivariate analysis were synchronous resection (
p
 = 0.02), a lower PCI score (
p
 = 0.12), and the CCS (
p
 = 0.09).
Conclusion
The cure rate of 11 % for patients with gastric carcinomatosis who are deemed terminal emphasizes that CRS and HIPEC should be considered in highly selected patients (low disease extent and complete CRS).