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Cytoreduction and HIPEC for Gastric Carcinomatosis: Multi-institutional Analysis of Two Phase II Clinical Trials

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

There are no approved locoregional therapies for peritoneal carcinomatosis from gastric adenocarcinoma (GA). Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) represents a potential treatment for advanced GA with isolated peritoneal metastasis.

Patients and Methods

Two separate single-institution phase II, single-arm studies evaluating CRS–HIPEC using cisplatin with mitomycin C (NIH: NCT03092518, MDACC: NCT02891447) in patients with GA and confirmed peritoneal metastasis were analyzed. The primary endpoint of each trial was overall survival (OS). Clinical, pathologic, and treatment variables were analyzed for association with outcomes.

Results

Over 4 years, 41 patients with peritoneal carcinomatosis from GA underwent CRS–HIPEC. All patients had synchronous peritoneal metastasis and received systemic chemotherapy as front-line therapy. A total of 23 patients also received laparoscopic HIPEC prior to open CRS–HIPEC. The majority (63%, n = 26) were male, and median PCI score at CRS–HIPEC was 2. Median OS was 24.9 months from diagnosis and 14.4 months from CRS–HIPEC. Three-year OS was 25% from diagnosis and 22% from CRS–HIPEC. Median RFS was 7.4 months. The rate of 30-day Clavien–Dindo grade ≥ 3 complications was 32%; specifically, the rate of anastomotic leak was 22%. Multivariable analysis identified the number of pathologically positive lymph nodes as an independent predictor of postoperative OS.

Conclusions

In patients with gastric adenocarcinoma and isolated peritoneal metastasis treated with CRS–HIPEC, 3-year OS was 22% from CRS–HIPEC, and complications were common. The number of pathologic lymph node metastases was inversely correlated with overall survival. Further investigation of CRS–HIPEC for GA should include patient selection based on response to systemic chemotherapy or incorporate novel intraperitoneal treatment strategies.

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Acknowledgement

We thank Dr. Martha Quezado and Dr. Markku Miettinen of the NIH Department of Pathology. We thank the NIH Molecular Pathology department for performing NGS. We thank Paul Juneau from the NIH Division of Library Services for statistical support.

Funding

This research was supported by the Intramural Research Program, National Institutes of Health, National Cancer Institute.

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Authors and Affiliations

  1. Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Benjamin L. Green MD, Lauren A. Gamble MD, James D. McDonald MD, Maureen Connolly BS, Monica Epstein BS, Jonathan M. Hernandez MD, Andrew M. Blakely MD & Jeremy L. Davis MD

  2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alisa N. Blumenthaler MD, Kristen Robinson MS & Brian D. Badgwell MD, MS

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  1. Benjamin L. Green MD
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  2. Alisa N. Blumenthaler MD
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  3. Lauren A. Gamble MD
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  4. James D. McDonald MD
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  5. Kristen Robinson MS
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  6. Maureen Connolly BS
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  7. Monica Epstein BS
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  8. Jonathan M. Hernandez MD
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  9. Andrew M. Blakely MD
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  10. Brian D. Badgwell MD, MS
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Corresponding authors

Correspondence to Brian D. Badgwell MD, MS or Jeremy L. Davis MD.

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Disclosure

Dr. Alisa Blumenthaler participated in a T32 research fellowship funded by the NIH from July 2019–June 2021, including work on this manuscript. The funder did not have any influence over the work included in this manuscript.

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Results from next-generation sequencing of primary tumor. (DOCX 41 kb)

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Green, B.L., Blumenthaler, A.N., Gamble, L.A. et al. Cytoreduction and HIPEC for Gastric Carcinomatosis: Multi-institutional Analysis of Two Phase II Clinical Trials. Ann Surg Oncol 30, 1852–1860 (2023). https://doi.org/10.1245/s10434-022-12761-0

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  • DOI: https://doi.org/10.1245/s10434-022-12761-0

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