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Pressurized intraperitoneal aerosol chemotherapy and its effect on gastric-cancer-derived peritoneal metastases: an overview

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Abstract

This manuscript aspires to portray a review of the current literature focusing on manifest peritoneal metastasis (PM) derived from gastric cancer and its treatment options. Despite the development of chemotherapy and multimodal treatment options during the last decades, mortality remains high worldwide. After refreshing important epidemiological considerations, the molecular mechanisms currently accepted through which PM occurs are revised. Palliative chemotherapy is the only recommended treatment option for patients with PM of gastric cancer according to the National Comprehensive Cancer Network guidelines, although cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy demonstrated promising results in selected patients with regional PM and localized intraabdominal tumor spread. A novel treatment named pressurized intraperitoneal aerosol chemotherapy may have a promising future in improving overall survival with an acceptable postoperative complication rate and stabilizing quality of life during treatment. Additionally, the procedure has been proved to be safe for the patient and medical personnel and a feasible, repeatable method to deter metastatic proliferation. This overview comprehensively addresses this novel and promising treatment in the context of a scientifically and clinically challenging disease.

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Abbreviations

ANXA1:

Anti-inflammatory protein Annexin 1

CAFs:

Cancer associated fibroblasts

CAWS:

Closed aerosol waste system

CCR:

Transmembrane G protein-coupled chemokine receptors

CDH1:

Calcium-dependent cell–cell adhesion molecule E-cadherin

CRS:

Cytoreductive surgery

CTGF:

Connective tissue growth factor

CXC/CC:

Chemokines

ECM:

Extracellular matrix

EMT:

Epithelial-mesenchymal transition

HIF-1α:

Hypoxia-inducible factor-1α

HIPEC:

Hyperthermic intraperitoneal chemotherapy

miRNA:

MicroRNAs

MMP:

Matrix metalloproteinase

MS:

Milky spots

MVD:

Microvascular density

NCCN:

National comprehensive cancer network

NIPS:

Neoadjuvant intraperitoneal-systemic chemotherapy protocol

NRAGE:

Neutrophin receptor-interacting melanoma antigen-encoding gene homolog

PCI:

Peritoneal cancer index

PIPAC:

Pressurized intraperitoneal aerosol chemotherapy

PM:

Peritoneal metastasis

PTEN:

Phosphatase and tensin homolog

S-1:

Tegafur, 5-chloro-2-4-dihydroxypyridine and oxonic acid

TAMs:

Tumor associated macrophages

VEGF:

Vascular endothelial growth factor

α-SMA:

Alpha-smooth muscle actin

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Authors and Affiliations

  1. Department of Surgery, Campus Virchow Klinikum – Campus Mitte, Charité – University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Miguel Alberto, Andreas Brandl, Safak Gül-Klein & Beate Rau

  2. Department of Surgery, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India

    Pankaj Kumar Garg

  3. Translational Oncology of Solid Tumors, Experimental and Clinical Research Center, Charité University Hospital Berlin, Berlin, Germany

    Mathias Dahlmann & Ulrike Stein

  4. Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Straße 10, 13125, Berlin, Germany

    Mathias Dahlmann & Ulrike Stein

  5. German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Mathias Dahlmann & Ulrike Stein

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  1. Miguel Alberto
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  2. Andreas Brandl
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  3. Pankaj Kumar Garg
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  4. Safak Gül-Klein
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  5. Mathias Dahlmann
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  6. Ulrike Stein
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  7. Beate Rau
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Correspondence to Beate Rau.

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Alberto, M., Brandl, A., Garg, P.K. et al. Pressurized intraperitoneal aerosol chemotherapy and its effect on gastric-cancer-derived peritoneal metastases: an overview. Clin Exp Metastasis 36, 1–14 (2019). https://doi.org/10.1007/s10585-019-09955-4

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