title: Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: Selection for cytoreductive surgery.
abstract: There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer. New bidirectional chemotherapy (neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)) was developed. The aim of the present study was to assess the safety and efficacy of NIPS and to show the selection for cytoreductive surgery on PC from gastric cancer. Seventy-nine patients with PC from gastric cancer were treated with NIPS. A peritoneal port system was introduced into the abdominal cavity. The peritoneal wash cytological examination through a port was done before and after NIPS. The patients were treated with oral TS-1 twice a daily for 21 days, followed by a 1-week rest. On day 1, 8, and 15 from the start of oral TS-1 administration, 30 mg/m(2) of Docetaxel and 30 mg/m(2) of cisplatinum with 500 ml of saline were introduced into the peritoneal cavity through the port. A median course of oral TS-1 was 2.1 course and a median time of IP chemoterapy was 5.8. Peritoneal free cancer cells (PFCCs) had been detected in 65 (82.2%) patients before NIPS, and the positive cytology changed to be negative in 41 (63.0%) patients after NIPS. After NIPS, 41 patients underwent laparotomy, and complete cytoreduction was done in 32 (78%) patients. Complete cytoreduction was done in 27 (51.9%) of 52 patients with negative cytology but in only 4 (14.8%) of 27 patients with positive cytology (P < 0.001). Patients with negative cytology after NIPS survived significantly longer than those with positive cytology. The adverse effects after NIPS were mild and there was no treatment-related deaths. The grade 3/4 hematological adverse effects were found in 2 (2.6%) patients. Grade 3 renal toxicity and port site infection was found in three patients, respectively. NIPS using a port system is a safe and effective treatment for PC. Peritoneal wash cytology through a port system is a good indicator to select the patients to perform cytoreductive surgery.
authors.affiliation: NPO Organization to Support Peritoneal Dissemination Treatment, Kishiwada, Osaka, Japan. y.yonemura@coda.ocn.ne.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemura
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Endou
authors.forename: Masaya
authors.initials: M
authors.lastname: Shinbo
authors.forename: Takuma
authors.initials: T
authors.lastname: Sasaki
authors.forename: Masamitu
authors.initials: M
authors.lastname: Hirano
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Mizumoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takao
authors.forename: Masumi
authors.initials: M
authors.lastname: Ichinose
authors.forename: Mitsukuni
authors.initials: M
authors.lastname: Mizuno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Miura
authors.forename: Makoto
authors.initials: M
authors.lastname: Ikeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikeda
authors.forename: Gou
authors.initials: G
authors.lastname: Nakajima
authors.forename: Jou
authors.initials: J
authors.lastname: Yonemura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Yuuba
authors.forename: Seiji
authors.initials: S
authors.lastname: Masuda
authors.forename: Hironobu
authors.initials: H
authors.lastname: Kimura
authors.forename: Nobuo
authors.initials: N
authors.lastname: Matsuki
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin