title: A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology.
abstract: Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most appropriate treatment regimen for this particular patient group. We reviewed and analyzed published data to determine the optimal treatment regimen for patients with peritoneal cytology-positive gastric adenocarcinomas. Six electronic databases were explored [PubMed, Cochrane (Systematic Reviews and Controlled Trials), PROSPERO, DARE, and EMBASE]. The primary outcome was overall survival with secondary outcomes including patterns of recurrence and treatment-related morbidity. Six studies were included for data extraction. There was no significant heterogeneity between studies. The use of S1 monotherapy was associated with a significant survival benefit (HR 0.48; 95% CI 0.32-0.70; p = 0.0002). Intraoperative intraperitoneal chemotherapy (IIPC) with adjuvant chemotherapy showed a trend toward improvement in overall survival (HR 0.70; 9 % CI 0.47-1.04; p = 0.08). A recent randomized controlled trial examining extensive intraperitoneal lavage (EIPL) with IIPC showed a significant improvement in overall survival (5-year overall survival, 43.8% for EIPL-IPC group compared with 4.6% for IPC group). However, these promising results need to be validated in larger prospective randomized trials.
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Centre, 7 St. Andrews Place, East Melbourne, VIC, 3002, Australia, carloscabalag@gmail.com.
authors.forename: Carlos Suhady
authors.initials: CS
authors.lastname: Cabalag
authors.forename: Steven Tuck Foo
authors.initials: ST
authors.lastname: Chan
authors.forename: Yui
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Cuong Phu
authors.initials: CP
authors.lastname: Duong
mesh_terms: D000284:Administration, Oral; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D007432:Intraoperative Period; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D010094:Oxonic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D010533:Peritoneal Lavage / Q000379:methods; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005641:Tegafur / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid