Intraperitoneal Chemotherapy for Gastric Cancer

Chapter

Abstract

Peritoneal metastases from gastric cancer have an ominous prognosis. Most of the patients present with advanced disease and respond poorly to systemic chemotherapy. Intraperitoneal chemotherapy has shown a benefit in the prevention of gastric PM when administered perioperatively in patients with advanced gastric cancer undergoing potentially curative surgery. Of the various modalities, hyperthermic intraperitoneal chemotherapy (HIPEC) has shown the best results. In the setting of synchronous PM, cytoreductive surgery and HIPEC along with systemic therapy can produce a prolonged disease-free survival and overall survival in selected patients with limited disease. Complete tumor removal and a PCI of <6 yield the best outcomes. Clearly, new modalities are needed to deal with this situation. Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) has shown good results in this setting. Patients who have a good response can further undergo CRS and HIPEC. In the setting of metachronous gastric PM, pressurized intraperitoneal chemotherapy has produced good responses and is currently a prospective evaluation. Patients in the far east, i.e., Japan and China, have significantly better outcomes than those in the rest of the world, and this should be borne in mind when extrapolating the results obtained in those countries to patients elsewhere.

Keywords

Gastric cancer Peritoneal metastases Cytoreductive surgery HIPEC NIPS Prophylactic HIPEC Adjuvant HIPEC 

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Surgical OncologyRajiv Gandhi Cancer Institute and Research CentreDelhiIndia

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