Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012:2012:148420.
doi: 10.1155/2012/148420. Epub 2012 Jul 31.

Effects of neoadjuvant intraperitoneal/systemic chemotherapy (bidirectional chemotherapy) for the treatment of patients with peritoneal metastasis from gastric cancer

Yutaka Yonemura  1 , Ayman Elnemr, Yoshio Endou, Haruaki Ishibashi, Akiyoshi Mizumoto, Masahiro Miura, Yan Li
Affiliations

Effects of neoadjuvant intraperitoneal/systemic chemotherapy (bidirectional chemotherapy) for the treatment of patients with peritoneal metastasis from gastric cancer

Yutaka Yonemura et al. Int J Surg Oncol. 2012.

Abstract

Novel multidisciplinary treatment combined with neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS) and peritonectomy was developed. Ninety-six patients were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. Patients were treated with 60 mg/m(2) of oral S-1 for 21 days, followed by a 1-week rest. On days 1, 8, and 15, 30 mg/m(2) of Taxotere and 30 mg/m(2) of cisplatin with 500 mL of saline were introduced through the port. NIPS is done 2 cycles before surgery. Three weeks after NIPS, 82 patients were eligible to intend cytoreductive surgery (CRS) by gastrectomy + D2 dissection + periotnectomy to achieve complete cytoreduction. Sixty-eight patients showed positice cytology before NIPS, and the positive cytology results became negative in 47 (69%) patients after NIPS. Complete pathologic response on PC after NIPS was experienced in 30 (36.8%) patients. Stage migration was experienced in 12 patients (14.6%). Complete cytoreduction was achieved in 58 patients (70.7%). By the multivariate analysis, complete cytoreduction and pathologic response became a significantly good survival. However the high morbidity and mortality, stringent patient selection is important. The best indications of the therapy are patients with good pathologic response and PCI ≤ 6, which are supposed to be removed completely by peritonectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Peritoneal cancer index (PCI). Peritoneal cavity is divided into 13 parts, which ranges from 0 to 12. Accurate measurement of each region is scored as lesion size 0 through 3. LS 0: no implants.
Figure 2
Figure 2
Survivals of 82 patients who underwent CRS, and 14 patients who did not underwent CRS.
Figure 3
Figure 3
Survival difference after CC-0 and CC-1 resection.
Figure 4
Figure 4
Survival difference of patients with PCI ≤ 6 and those with PCI ≥ 7.
Figure 5
Figure 5
Survival difference of patients, according to the histological response on PC after NIPS.
See this image and copyright information in PMC

References

    1. Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358–363. - PubMed
    1. Preusser P, Wilke H, Achterrath W, et al. Phase II study with the combination etoposide, doxorubicin, and cisplatin in advanced measurable gastric cancer. Journal of Clinical Oncology. 1989;7(9):1310–1317. - PubMed
    1. Ajani JA, Ota DM, Jessup JM, et al. Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy. Cancer. 1991;68(7):1501–1506. - PubMed
    1. Sugarbaker PH. Peritonectomy procedures. Annals of Surgery. 1995;221(1):29–42. - PMC - PubMed
    1. Yonemura Y, Bandou E, Kinoshita K, et al. Effective therapy for peritoneal dissemination in gastric cancer. Surgical Oncology Clinics of North America. 2003;12(3):635–648. - PubMed

LinkOut - more resources