Safety and preliminary results of perioperative chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for high-risk gastric cancer patients

World Journal of Surgical Oncology

Celso A L Mello²  Marcelo F Fanelli²  Milton J B Silva²  MariaDirleiFS Begnami³  André Luís de Godoy¹  Alessandro L Diniz¹  Héber S C Ribeiro¹  Felipe J F Coimbra¹  Wilson L Costa¹ 

[1] Department of Abdominal Surgery, Hospital A. C. Camargo, Rua Antonio Prudente, 211 Liberdade CEP, 01501-900, Sao Paulo, Brazil;Department of Clinical Oncology, Hospital A. C. Camargo, Rua Antonio Prudente, 211 Liberdade CEP, 01501-900, Sao Paulo, Brazil;Department of Surgical Pathology, Hospital A. C. Camargo, Rua Antonio Prudente, 211 Liberdade CEP, 01501-900, Sao Paulo, Brazil

关键词: Perioperative chemotherapy;    HIPEC;    Gastric cancer;   

Others  :  827263
DOI  :  10.1186/1477-7819-10-195

 received in 2012-04-01, accepted in 2012-07-16,  发布年份 2012

【 摘 要 】

Background

Gastric cancer relapse occurs in about 30% of the patients treated with gastrectomy and D2-lymphadenectomy, mainly as distant or peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with an improvement in survival and lower peritoneal recurrence, albeit with increased morbidity. The aim of this study is to report the preliminary results of the association of perioperative chemotherapy, radical surgery and HIPEC in high-risk gastric patients in a single institution.

Methods

Treatment protocol was started in 2007 and included patients younger than 65 years old, with good performance status and gastric adenocarcinoma with serosa involvement and lymph node metastases, located in the body or antrum. Patients should receive three preoperative cycles of DCF (Docetaxel 75 mg/m², Cisplatin 75 mg/m² and continuous intravenous infusion of 5-Fluorouracil 750 mg/m² for 5 days), followed by gastric resection with D2-lymphadenectomy, hyperthermic intraperitoneal chemotherapy with Mytomicin C 34 mg/m² and three more postoperative cycles of DCF.

Results

Ten patients were included between 2007 and 2011. Their median age was 47 years old and six were male. Nine were staged with cT4 cN + tumors and one as cT3 cN+. Nine patients completed all three preoperative chemotherapy cycles. Eight individuals were treated with a total gastrectomy and the other two had a distal gastrectomy, all having HIPEC. Postoperative morbidity was 50%, with no deaths. Regarding postoperative chemotherapy, only 5 patients completed three cycles. With a median follow-up of 25 months, three relapses were identified and 7 patients remain disease-free, two with more than 4 years of follow-up.

Conclusion

The association of perioperative systemic and intraperitoneal chemotherapy plus radical surgery is a feasible multimodality treatment, with acceptable morbidity. With a longer follow-up and a larger group of patients, we hope to be able to determine if it also influences survival outcomes and patterns of recurrence.

Mini-Abstract

The association of perioperative chemotherapy, gastric resection and D2-lymphadenectomy and hyperthermic intraperitoneal chemotherapy proved to be associated with acceptable morbidity. For survival analysis, a longer follow-up is needed.

【 授权许可】

   
2012 Costa et al.; licensee BioMed Central Ltd.

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