Gastric peritoneal carcinomatosis - a retrospective review.
OBJECTIVE
To characterize patients with gastric peritoneal carcinomatosis (PC) and their typical clinical and treatment course with palliative systemic chemotherapy as the current standard of care.


METHODS
We performed a retrospective electronic chart review of all patients with gastric adenocarcinoma with PC diagnosed at initial metastatic presentation between January 2010 and December 2014 in a single tertiary referral centre.


RESULTS
We studied a total of 271 patients with a median age of 63.8 years and median follow-up duration of 5.1 mo. The majority (n= 217, 80.1%) had the peritoneum as the only site of metastasis at initial presentation. Palliative systemic chemotherapy was eventually planned for 175 (64.6%) of our patients at initial presentation, of which 171 were initiated on it. Choice of first-line regime was in accordance with the National Comprehensive Cancer Network Guidelines for Gastric Cancer Treatment. These patients underwent a median of one line of chemotherapy, completing a median of six cycles in total. Chemotherapy disruption due to unplanned hospitalizations occurred in 114 (66.7%), while cessation of chemotherapy occurred in 157 (91.8%), with 42 cessations primarily attributable to PC-related complications. Patients who had initiation of systemic chemotherapy had a significantly better median overall survival than those who did not (10.9 movs1.6 mo,P< 0.001). Of patients who had initiation of systemic chemotherapy, those who experienced any disruptions to chemotherapy due to unplanned hospitalizations had a significantly worse median overall survival compared to those who did not (8.7 movs14.6 mo,P< 0.001).


CONCLUSIONS
Gastric PC carries a grim prognosis with a clinical course fraught with disease-related complications which may attenuate any survival benefit which palliative systemic chemotherapy may have to offer. As such, investigational use of regional therapies is warranted and required validation in patients with isolated PC to maximize their survival outcomes in the long run.
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Hwee Leong
HL
Tan
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Claramae Shulyn
CS
Chia
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Grace Hwei Ching
GH
Tan
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Su Pin
SP
Choo
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
David Wai-Meng
DW
Tai
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Clarinda Wei Ling
CW
Chua
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Matthew Chau Hsien
MC
Ng
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Khee Chee
KC
Soo
Hwee Leong Tan, Claramae Shulyn Chia, Grace Hwei Ching Tan, Khee Chee Soo, Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
Melissa Ching Ching
MC
Teo
Gastric cancer; Peritoneal carcinomatosis