Gastrectomy, peritonectomy, and perioperative intraperitoneal chemotherapy: The evolution of treatment strategies for advanced gastric cancer

2003 ◽  
Vol 21 (4) ◽  
pp. 233-248 ◽  
Author(s):  
Paul H. Sugarbaker ◽  
Wansik Yu ◽  
Yutaka Yonemura
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Treatment Strategies

scholarly journals Immunotherapy in Advanced Gastric Cancer: An Overview of the Emerging Strategies

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Helena Magalhães ◽  
Mário Fontes-Sousa ◽  
Manuela Machado
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Median Overall Survival ◽  
Systemic Disease ◽  
Treatment Strategies ◽  
Public Health Problem ◽  
Molecular Classification ◽  
Current Evidence ◽  
Curative Intent

Gastric cancer (GC) remains a public health problem, being the fifth most common cancer worldwide. In the western countries, the majority of patients present with advanced disease. Additionally, 65 to 75% of patients treated with curative intent will relapse and develop systemic disease. In metastatic disease, systemic treatment still represents the state of the art, with less than a year of median overall survival. The new molecular classification of GC was published in 2014, identifying four distinct major subtypes of gastric cancer, and has encouraged the investigation of new and more personalized treatment strategies. This paper will review the current evidence of immunotherapy in advanced gastric cancer.

A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for advanced gastric cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4614-4614 ◽  
Author(s):  
T. D. Yan ◽  
D. Black ◽  
P. H. Sugarbaker ◽  
Y. Yonemura ◽  
J. Zhu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Advanced Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Data Extraction ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Abdominal Abscess ◽  
Term Survival

4614 Objectives: Despite the use of adjuvant systemic chemotherapy or radiotherapy, the long-term survival in patients with stage III and IV gastric cancer remains limited. The purpose of this systematic review and meta-analysis was to determine the effectiveness and safety of adjuvant intraperitoneal chemotherapy for patients with advanced gastric cancer. Methods: Studies eligible for this systematic review included those in which patients with gastric cancer were randomly assigned to receive surgery combined with intraperitoneal chemotherapy versus surgery without intraperitoneal chemotherapy. All forms of intraperitoneal chemotherapy in addition to surgery were included. There were no language restrictions. Quality of the trials was assessed by a predetermined checklist. The primary end-point of the meta-analysis was overall survival, defined as the time from random assignment to the last follow-up or death. Secondary end-points were the differences in the incidence of recurrence, morbidity and mortality. Results: Thirteen reports of randomised controlled trials (RCTs) were included for appraisal and data extraction. Ten reports were judged fair-quality and subjected to the meta-analysis. A significant improvement in survival was associated with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) alone (HR = 0.60; 95% CI = 0.43 to 0.83; p = 0.002) or combined with early postoperative intraperitoneal chemotherapy (EPIC) (HR = 0.45; 95% CI = 0.29 to 0.68; p = 0.0002). Survival improvement was marginally significant (HR = 0.67; 95% CI = 0.44 to 1.01; p = 0.06) with normothermic intraoperative intraperitoneal chemotherapy, but not significant with EPIC alone or delayed postoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy was also found to be associated with higher risks for intra-abdominal abscess (RR = 2.37; 95% CI = 1.32 to 4.26; p = 0.003) and neutropenia (RR = 4.33; 95% CI = 1.49 to 12.61; p = 0.007). Conclusion: The present meta-analysis indicates that HIIC with or without EPIC after resection of advanced gastric primary cancer is associated with an improved overall survival. However, increased risks of intra-abdominal abscess and neutropenia are demonstrated. No significant financial relationships to disclose.

scholarly journals Advanced gastric cancer: new perspectives of treatment

2016 ◽  
Author(s):  
Matteo Nardi ◽  
Luca Ansaloni ◽  
Giulia Montori ◽  
Marco Ceresoli ◽  
Giacomo Crescentini ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Survival Rates ◽  
Comprehensive Treatment ◽  
Peritoneal Carcinosis ◽  
Curative Intent ◽  
One Year

The prognosis in patients with advanced gastric cancer with carcinosis remains poor with a median survival of less than one year. High rates of peritoneal recurrence of patients undergoing resection with potentially curative intent are strictly related with lymphatic spread and penetration of the serosa. To increase survival rates, during the last thirty years different strategies about screening and treatment have been tested and proposed. Early detection of occult peritoneal micrometastasis is a base step to reduce local and serosa recurrences and to offer a tailored surgical and neoadjuvant therapeutic treatment. The complete cytoreductive surgery, however, remains the cornerstone of treatment. It could be associated with different combinations of chemotherapy regimens. Adjuvant, neoadjuvant and intraperitoneal chemotherapy have been demonstrated effective in improving the survival. In the last years, a few new molecules have been introduced which enhance the effect of chemotherapy by biologically targeting its objective. Lastly the prevention of macroscopic peritoneal carcinosis in all those patients at high risk due to serosal infiltration by treating them with intraperitoneal chemotherapy has been demonstrated to be one of the future winning approaches. In patients with peritoneal carcionosis, multimodal comprehensive treatment should be mandatory, with a pivotal role of intraperitoneal chemotherapy associate to CC0 cytoreduction. Neoadjuvant chemotherapy followed by cytoreductive surgery and intraperitoneal chemotherapy gave promising results. The new molecules as monoclonal antibodies seem to improve outcomes.

Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials

2014 ◽  
Vol 40 (1) ◽  
pp. 12-26 ◽  
Author(s):  
F. Coccolini ◽  
E. Cotte ◽  
O. Glehen ◽  
M. Lotti ◽  
E. Poiasina ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Randomized Trials ◽  
Meta Analysis
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