title: Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer.
abstract: BACKGROUND
  The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated.
  
  
  METHODS
  In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied.
  
  
  RESULTS
  In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients.
  
  
  CONCLUSIONS
  NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.
authors: NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan. y.yonemura@coda.ocn.ne.jp.|Department of Regional Cancer Therapies, Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Japan. y.yonemura@coda.ocn.ne.jp.|Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan. y.yonemura@coda.ocn.ne.jp.|Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan. y.yonemura@coda.ocn.ne.jp.
authors: Yutaka
authors: Y
authors: Yonemura
authors: Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors: Haruaki
authors: H
authors: Ishibashi
authors: Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors: Masamitu
authors: M
authors: Hirano
authors: Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors: Akiyoshi
authors: A
authors: Mizumoto
authors: Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors: Kazuyosi
authors: K
authors: Takeshita
authors: Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors: Kousuke
authors: K
authors: Noguchi
authors: Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors: Nobuyuki
authors: N
authors: Takao
authors: Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors: Masumi
authors: M
authors: Ichinose
authors: NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan.|Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors: Yang
authors: Y
authors: Liu
authors: Department of Peritoneal Surface Oncology, Beijing Shijitan Hospital of Capital Medical University, Beijing, China.
authors: Yan
authors: Y
authors: Li
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000401:mortality*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000401:mortality*; D010535:Laparoscopy / Q000401:mortality*; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy / Q000401:mortality*; D010534:Peritoneal Neoplasms / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate