title: Intraperitoneal Paclitaxel is useful as adjuvant chemotherapy for advanced gastric cancer with serosal exposure.
abstract: BACKGROUND
  Intraperitoneal administration of paclitaxel (PTX) can elicit a marked clinical response in peritoneal metastases of gastric cancer.
  
  
  METHODS
  In this study, we retrospectively analyzed the clinical outcome of 17 patients who underwent R0 resection with D2 dissection for advanced gastric cancer with macroscopic serosal exposure and received intraperitoneal PTX as adjuvant therapy.
  
  
  RESULTS
  A pathological study revealed that the depth of invasion of the primary tumor was pT4a or pT4b in 10 cases, and that the pN stage was more than pN2 in 8 cases. Genetic analysis of peritoneal lavage fluid was performed in 14 cases, all of which were positive for carcinoembryonic antigen mRNA. In these patients, PTX was intraperitoneally administered at 20-60 mg/m(2) with oral S-1 for 3-36 months after surgery. In a median follow-up period of 66 months, recurrence occurred in the liver and peritoneum in 2 (11.7%) and 1 (5.9%) patients, respectively, and no nodal recurrence was observed. Five-year overall survival and disease-free survival were 88.2 and 82.3%, respectively.
  
  
  CONCLUSIONS
  Since these patients are considered to be a high-risk group for peritoneal recurrence, this result strongly suggests that adjuvant chemotherapy including intraperitoneal PTX is a promising protocol to improve the outcome of patients with advanced gastric cancer with serosal exposure.
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishigami
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Emoto
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
keywords: Gastric cancer; Intraperitoneal chemotherapy; Nodal recurrence; Paclitaxel; Peritoneal recurrence; Serosal invasion