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Tumor Biology

, Volume 34, Issue 1, pp 463–469 | Cite as

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves the survival of gastric cancer patients with ovarian metastasis and peritoneal dissemination

  • Xiao-Jiang Wu
  • Peng Yuan
  • Zi-Yu Li
  • Zhao-De Bu
  • Lian-Hai Zhang
  • Ai-Wen Wu
  • Xiang-Long Zong
  • Shuang-Xi Li
  • Fei Shan
  • Xin Ji
  • Hui Ren
  • Jia-Fu Ji
Research Article

Abstract

The prognosis for ovarian metastasis of gastric cancer is poor. There is no currently available treatment for this disease. The purpose of this study was to evaluate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) in female gastric cancer patients with metachronous ovarian metastasis. From January 2000 to December 2010, 62 patients developed ovarian metastasis after undergoing gastrectomy with D2 lymphadenectomy. Thirty-two patients underwent CRS plus HIPEC, and 30 patients underwent CRS alone. The median age of all 62 patients was 44 years (range 19–71 years). Metastatic carcinoma involving bilateral ovaries was observed in 50 patients (80.6 %). The median survival time in the CRS + HIPEC group was 15.5 months (95 % confidence interval [CI] 12.1–18.9 months) but was only 10.4 months (95 % CI 8.5–12.2 months) in the CRS group (P = 0.018). Among the 32 patients with pelvic peritoneal metastasis, a stratified analysis revealed that the median survival period for the 15 patients treated with CRS + HIPEC was significantly higher than that for the patients treated with CRS alone (P = 0.046). Among the 30 patients who suffered from ovarian metastasis alone, the median survival times were similar in both groups (P = 0.141). A multivariate analysis revealed that CRS + HIPEC and a low Peritoneal Cancer Index (PCI) were independent predictors for improved survival. In conclusion, our study indicates that employing the HIPEC procedure after CRS could improve the survival time of patients with ovarian metastasis with few complications; however, we do not recommend HIPEC treatment for ovarian metastasis alone.

Keywords

Ovarian metastasis Gastric cancer Peritoneal dissemination Hyperthermic intraperitoneal chemotherapy Cytoreductive surgery 

Notes

Conflict of interest

None.

References

  1. 1.
    Chen WQ, Zhang SW, Zou XN, et al. Cancer incidence and mortality in China, 2006. Chin J Cancer Res. 2011;23(1):3–9.CrossRefGoogle Scholar
  2. 2.
    Kim HK, Heo DS, Bang YJ, Kim NK. Prognostic factors of Krukenberg's tumor. Gynecol Oncol. 2001;82(1):105–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol. 2006;30(3):277–99.PubMedGoogle Scholar
  4. 4.
    Deslauriers N, Olney H, Younan R. Splenectomy revisited in 2011: impact on hematologic toxicities while performing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Gastrointest Oncol. 2011;2(2):61–3.PubMedGoogle Scholar
  5. 5.
    Cheong JH, Hyung WJ, Chen J, Kim J, Choi SH, Noh SH. Survival benefit of metastasectomy for Krukenberg tumors from gastric cancer. Gynecol Oncol. 2004;94(2):477–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Jiang R, Tang J, Cheng X, Zang RY. Surgical treatment for patients with different origins of Krukenberg tumors: outcomes and prognostic factors. Eur J Surg Oncol. 2009;35(1):92–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Jun SY, Park JK. Metachronous ovarian metastases following resection of the primary gastric cancer. J Gastric Cancer. 2011;11(1):31–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Yook JH, Oh ST, Kim BS. Clinical prognostic factors for ovarian metastasis in women with gastric cancer. Hepatogastroenterology. 2007;54(75):955–9.PubMedGoogle Scholar
  9. 9.
    Kim NK, Kim HK, Park BJ, Kim MS, Kim YI, Heo DS, et al. Risk factors for ovarian metastasis following curative resection of gastric adenocarcinoma. Cancer. 1999;85(7):1490–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Lu TP, Tsai MH, Hsiao CK, Lai LC, Chuang EY. Expression and functions of semaphorins in cancer. Transl Cancer Res. 2012;1(2):74–87.Google Scholar
  11. 11.
    Krukenberg F. Uber das fibrosarcoma ovarii mucocellulase (carcinomatoses). Arch Gynecol Obstet. 1896;50:287–321.Google Scholar
  12. 12.
    Serov SF, Scully RE, Sobin LH. International histological classification of tumors. No 9. Histological Typing of Ovarian Tumors. Geneva: WHO; 1973. p. 17–54.Google Scholar
  13. 13.
    Yada-Hashimoto N, Yamamoto T, Kamiura S, Seino H, Ohira H, Sawai K, et al. Metastatic ovarian tumors: a review of 64 cases. Gynecol Oncol. 2003;89(2):314–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Kobayashi O, Sugiyama Y, Cho H, Tsuburaya A, Sairenji M, Motohashi H, et al. Clinical and pathological study of gastric cancer with ovarian metastasis. Int J Clin Oncol. 2003;8(2):67–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004;5(4):219–28.PubMedCrossRefGoogle Scholar
  16. 16.
    Sugarbaker PH, Stuart OA, Bijelic L. Intraperitoneal gemcitabine chemotherapy as an adjuvant treatment for patients with resected pancreatic cancer: phase II and pharmacologic studies. Transl Gastrointest Cancer. 2012;1(2):161–8.Google Scholar
  17. 17.
    Yan TD, Black D, Sugarbaker PH, Zhu J, Yonemura Y, Petrou G, et al. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol. 2007;14(10):2702–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Fujimoto S, Shrestha RD, Kokubun M, Ohta M, Takahashi M, Kobayashi K, et al. Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding. Ann Surg. 1988;208(1):36–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Li C, Yan M, Chen J, Xiang M, Zhu ZG, Yin HR, et al. Surgical resection with hyperthermic intraperitoneal chemotherapy for gastric cancer patients with peritoneal dissemination. J Surg Oncol. 2010;102(5):361–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Yang XJ, Huang CQ, Suo T, Mei LJ, Yang GL, Cheng FL, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011;18(6):1575–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379(9813):315–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Bouchereau M, Gervais M, Sideris L, Loriot M, Ahern S, Dubé P. Hepatic necrosis and hemorrhage following hyperthermic intraperitoneal chemotherapy with oxaliplatin: a review of two cases. J Gastrointest Oncol. 2011;2(2):113–6.PubMedGoogle Scholar
  23. 23.
    Park SR, Kong SY, Rhee J, Park YI, Ryu KW, Lee JH, et al. Phase II study of a triplet regimen of S-1 combined with irinotecan and oxaliplatin in patients with metastatic gastric cancer: clinical and pharmacogenetic results. Ann Oncol. 2011;22(4):890–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Al-Batran SE, Hartmann JT, Probst S, Schmalenberg H, Hollerbach S, Hofheinz R, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol. 2008;26(9):1435–42.PubMedCrossRefGoogle Scholar
  25. 25.
    Glehen O, Gilly FN, Arvieux C, Cotte E, Boutitie F, Mansvelt B, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17(9):2370–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Glehen O, Gilly FN, Boutitie F, Bereder JM, Quenet F, Sideris L, et al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer. 2010;116(24):5608–18.PubMedCrossRefGoogle Scholar
  27. 27.
    Esquivel J. Technology of hyperthermic intraperitoneal chemotherapy in the United States, Europe, China, Japan, and Korea. Cancer J. 2009;15(3):249–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Kakushima N, Kamoshida T, Hirai S, Hotta S, Hirayama T, Yamada J, et al. Early gastric cancer with Krukenberg tumor and review of cases of intramucosal gastric cancers with Krukenberg tumor. J Gastroenterol. 2003;38(12):1176–80.PubMedCrossRefGoogle Scholar
  29. 29.
    Elias D, Blot F, Otmany A El, Antoun S, Lasser P, Boige V, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer. 2001;92(1):71–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Piso P, Slowik P, Popp F, Dahlke MH, Glockzin G, Schlitt HJ. Safety of gastric resections during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2009;16(8):2188–94.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2012

Authors and Affiliations

  • Xiao-Jiang Wu
    • 1
  • Peng Yuan
    • 1
  • Zi-Yu Li
    • 1
  • Zhao-De Bu
    • 1
  • Lian-Hai Zhang
    • 1
  • Ai-Wen Wu
    • 1
  • Xiang-Long Zong
    • 1
  • Shuang-Xi Li
    • 1
  • Fei Shan
    • 1
  • Xin Ji
    • 1
  • Hui Ren
    • 1
  • Jia-Fu Ji
    • 1
  1. 1.Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital, Beijing Cancer Hospital & InstituteBeijingChina

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