title: Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial.
abstract: BACKGROUND
  A prospective randomized trial was conducted to compare the impact of systemic chemotherapy versus multi-modality therapy (complete cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and systemic chemotherapy) on overall survival (OS) in patients with gastric carcinomatosis.
  
  
  METHODS
  Patients with measurable metastatic gastric adenocarcinoma involving the peritoneum, and resectable to "no evidence of disease" were randomized to gastrectomy, metastasectomy, HIPEC, and systemic FOLFOXIRI (GYMS arm) or FOLFOXIRI alone (SA arm).
  
  
  RESULTS
  Seventeen patients were enrolled (16 evaluable); 7 of 9 patients in the multi-modality GYMS arm achieved complete cytoreduction (CCR0). Median OS was 11.3 months in the GYMS arm and 4.3 months in the SA arm. Four patients in the GYMS arm survived >12 months, 2 patients close to 2 years at last follow-up, and 1 patient more than 4 years, with 2 of these patients still alive. No patient in the SA arm lived beyond 11 months. All patients surviving beyond 12 months in the surgery arm achieved complete cytoreduction and had an initial Peritoneal Cancer Index (PCI) of ≤ 15.
  
  
  CONCLUSIONS
  Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival.
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Udo
authors.initials: U
authors.lastname: Rudloff
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.forename: John E
authors.initials: JE
authors.lastname: Mullinax
authors.forename: Joal D
authors.initials: JD
authors.lastname: Beane
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Tatiana
authors.initials: T
authors.lastname: Beresnev
authors.forename: Carole C
authors.initials: CC
authors.lastname: Webb
authors.forename: Melissa
authors.initials: M
authors.lastname: Walker
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Toomey
authors.forename: David
authors.initials: D
authors.lastname: Schrump
authors.forename: Prakash
authors.initials: P
authors.lastname: Pandalai
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Itzhak
authors.initials: I
authors.lastname: Avital
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005743:Gastrectomy; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: cytoreductive surgery; heated intraperitoneal chemotherapy (HIPEC); metastasectomy; metastatic gastric cancer