title: Phase II study of patients with peritoneal carcinomatosis from gastric cancer treated with preoperative systemic chemotherapy followed by peritonectomy and intraperitoneal chemotherapy.
abstract: BACKGROUND
  The aim was to evaluate the feasibility and the effectiveness of neoadjuvant systemic chemotherapy followed by cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) in patients with peritoneal carcinomatosis (PC) from gastric cancer.
  
  
  METHODS
  Eighteen patients (median age 57 years, range 38-74) were scheduled for three months' neoadjuvant systemic chemotherapy followed by CRS + HIPEC + EPIC.
  
  
  RESULTS
  At the time of surgery, the peritoneal tumor burden was extensive with tumor growth on the entire peritoneal cavity. Only eight patients received the entire treatment and OS was 14.3 months (range 6.1-34.3, 95% CI 6.6-20.3). Six patients had macroscopically radical (CC0) surgery and for this subgroup OS was 19.1 months (range 6.1-34.3, 95% CI 6.9-27.1). Postoperative 90-day mortality was 10% (one patient) and the perioperative grades II-IV adverse events (AE) rate was 62.5%.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy followed by CRS + HIPEC + EPIC does not seem to be associated with prolonged OS in patients with extensive PC growth from gastric cancer unless macroscopically radical surgery is achieved. However, morbidity from this treatment is considerable and it cannot be recommended for routine care until a prospective randomized trial has been performed.
authors.affiliation: Department of Surgical Sciences, Section of Surgery, Uppsala University, Uppsala, Sweden. bo.hultman@surgsci.uu.se
authors.forename: Bo
authors.initials: B
authors.lastname: Hultman
authors.forename: Pehr
authors.initials: P
authors.lastname: Lind
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
authors.forename: Peter
authors.initials: P
authors.lastname: Nygren
authors.forename: Ulf
authors.initials: U
authors.lastname: Haglund
authors.forename: Haile
authors.initials: H
authors.lastname: Mahteme
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002277:Carcinoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*