title: Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility?
abstract: Peritoneal carcinomatosis is an increasingly common finding in gastric carcinoma. Previously, patients were treated as terminal, and median survival was poor. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this context is still highly debatable.
  
  
  
  The aim of this study was to evaluate the long-term outcomes associated with CRS and HIPEC, and define prognostic factors for cure, if possible.
  
  
  
  All patients with gastric carcinomatosis from five French institutions who underwent combined complete CRS and HIPEC and had a minimum follow-up of 5 years were included in this study. Cure was defined as a disease-free interval of more than 5 years from the last treatment until the last follow-up.
  
  
  
  Of the 81 patients who underwent CRS and HIPEC from 1989 to 2009, 59 had a completeness of cytoreduction score (CCS) of 0 (complete macroscopic resection), and the median Peritoneal Cancer Index (PCI) score was 6. Mitomycin C was the most commonly used drug during HIPEC (88 %). The 5-year overall survival (OS) rate was 18 %, with nine patients still disease-free at 5 years, for a cure rate of 11 %. All 'cured' patients had a PCI score below 7 and a CCS of 0. Factors associated with improved OS on multivariate analysis were synchronous resection (p = 0.02), a lower PCI score (p = 0.12), and the CCS (p = 0.09).
  
  
  
  The cure rate of 11 % for patients with gastric carcinomatosis who are deemed terminal emphasizes that CRS and HIPEC should be considered in highly selected patients (low disease extent and complete CRS).
authors.affiliation: Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France. clamchia@gmail.com.
authors.forename: C S
authors.initials: CS
authors.lastname: Chia
authors.affiliation: Hospices Civils de Lyon, Department of Oncology, Cancer Institute of HCL, Pierre Bénite, France.|Université Lyon 1, Research Unit EMR 3738, Lyon, France.
authors.forename: B
authors.initials: B
authors.lastname: You
authors.affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France.|Université de Lyon, RECIF, EA Santé Individu Société 4129, Lyon, France.|Université Lyon 1, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Decullier
authors.affiliation: Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France.
authors.forename: D
authors.initials: D
authors.lastname: Vaudoyer
authors.affiliation: Service de Chirurgie Digestive et Cancérologique, Centre P. Papin, Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Lorimier
authors.affiliation: Service de Chirurgie Générale, Hopital Nord, St Etienne, France.|Université Lyon 1, Research Unit EMR 3738, Lyon, France.
authors.forename: K
authors.initials: K
authors.lastname: Abboud
authors.affiliation: Service de Chirurgie Générale et Cancérologie Digestive, CHU L'Archet II, Nice, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Bereder
authors.affiliation: Service de Chirurgie Digestive, CHU A. Michallon, Grenoble, France.|Université Lyon 1, Research Unit EMR 3738, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Department of Hepatogastroenterology, Cancer Institute of HCL, Lyon Sud, Pierre Bénite, France.
authors.forename: G
authors.initials: G
authors.lastname: Boschetti
authors.affiliation: Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France.|Université Lyon 1, Research Unit EMR 3738, Lyon, France.|Surgical Oncology Department, CHRU Lyon Sud, Pierre Bénite, Cedex, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult