title: Treatment and prevention of peritoneal carcinomatosis from gastric cancer by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: overview and rationale.
abstract: Peritoneal carcinomatosis (PC) from gastric cancer is a condition with a very bleak prognosis. Most authors consider it to be a terminal disease and recommend palliative therapy only. Multimodal therapeutic approaches to PC have emerged in the last decades, combining cytoreductive surgery (CRS) and peritonectomy procedures with perioperative intraperitoneal chemotherapy (IPEC), including hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC). We reviewed the pertinent literature concerning the HIPEC modality both for the treatment of established PC and the prevention of peritoneal recurrence after potentially curative gastric cancer (GC) surgery. Basically, the two procedures relate to different aspects of GC and they are not comparable, since the latter has been used as an adjuvant when PC is still not macroscopically evident and the former has been exclusively used in advanced gastric cancer stages with peritoneal dissemination. Data supporting beneficial effects once gastric PC is already manifest is scarce and limited to few centres with specific experience in this field. Conversely, with regards to the peritoneal perfusion for preventing PC in high risk gastric cancer patients, there are phase III trials and meta-analysis which support beneficial effects resulting from the HIPEC procedure. To offer a baseline guide, we summarized the actual status and general outcome obtained by this multimodal technique, in association or not with CRS as treatment of advanced GC.
authors.affiliation: Department of Human Pathology and Oncology, Section of General Surgery and Surgical Oncology, University of Siena, Viale Bracci-Policlinico "Le Scotte", 53100 Siena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.forename: S
authors.initials: S
authors.lastname: Caruso
authors.forename: A
authors.initials: A
authors.lastname: Neri
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002277:Carcinoma / Q000517:prevention & control / Q000556:secondary* / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D006801:Humans; D006979:Hyperthermia, Induced; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010534:Peritoneal Neoplasms / Q000517:prevention & control / Q000556:secondary* / Q000628:therapy*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents
keywords: Gastric cancer; Hyperthermic intraperitoneal chemotherapy; Perioperative intraperitoneal chemotherapy; Peritoneal carcinomatosis