Pressurized intraperitoneal aerosol chemotherapy and its effect on gastric-cancer-derived peritoneal metastases: an overview
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.
Keywords
Gastric cancer Peritoneal metastases Pressurized intraperitoneal aerosol chemotherapy Intraperitoneal chemotherapy Hyperthermic Intraperitoneal Chemotherapy Molecular mechanisms of peritoneal metastasisAbbreviations
- 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
Notes
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
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