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Perioperative intraperitoneal plus systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for gastric cancer: phase Ib/II single-arm prospective study

Authors
 Minah Cho  ;  Hyo Song Kim  ;  Minkyu Jung  ;  Woo Jin Hyung 
Citation
 JOURNAL OF GASTROINTESTINAL SURGERY, Vol.28(7) : 1095-1103, 2024-07 
Journal Title
JOURNAL OF GASTROINTESTINAL SURGERY
ISSN
 1091-255X 
Issue Date
2024-07
MeSH
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols* / administration & dosage ; Antineoplastic Combined Chemotherapy Protocols* / therapeutic use ; Cisplatin* / administration & dosage ; Combined Modality Therapy ; Cytoreduction Surgical Procedures* ; Drug Combinations ; Female ; Humans ; Hyperthermic Intraperitoneal Chemotherapy* / methods ; Male ; Middle Aged ; Oxonic Acid / administration & dosage ; Paclitaxel* / administration & dosage ; Peritoneal Neoplasms* / mortality ; Peritoneal Neoplasms* / secondary ; Peritoneal Neoplasms* / therapy ; Prospective Studies ; Stomach Neoplasms* / mortality ; Stomach Neoplasms* / pathology ; Stomach Neoplasms* / therapy ; Survival Rate ; Tegafur / administration & dosage
Keywords
Cytoreductive surgery ; Gastric cancer ; Hyperthermic intraperitoneal chemotherapy ; Intraperitoneal chemotherapy ; Peritoneal metastasis
Abstract
Background: In gastric cancer, peritoneal metastasis is the most common form of metastasis and leads to dismal prognosis. We aimed to evaluate the safety and efficacy of combining perioperative intraperitoneal (IP) plus systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer with limited peritoneal metastasis or even after reducing peritoneal tumor burden by upfront IP chemotherapy. Method: Patients were enrolled in phase Ib in a 3 + 3 dose escalation of IP paclitaxel plus a fixed dose of IP cisplatin and oral S-1. In phase II, patients were managed according to the peritoneal cancer index (PCI) by diagnostic laparoscopy. For patients with a PCI of >12, upfront IP and systemic chemotherapy were given. Patients with a PCI of ≤12 or reduced to ≤12 after upfront chemotherapy underwent CRS with HIPEC. The primary endpoints were safety and the recommended phase II dose (RP2D) confirmation for phase Ib and the 1-year overall survival rate for phase II. Results: The RP2D was defined as IP 175 mg/m2 paclitaxel and 60 mg/m2 cisplatin and oral 70 mg/m2/day S-1 for 14 days. A total of 22 patients were included. After CRS with HIPEC, there were no grade 3 or higher complications. The median hospital stay was 7 days (range, 6–11). The median overall and progression-free survival were 27.3 months (95% CI, 14.4 to not estimable) and 12.6 months (95% CI, 7.7–14.5), respectively. One-year overall and progression-free survival rates were 81.0% (95% CI, 65.8–99.6) and 54.5% (95% CI, 37.2–79.9), respectively. Conclusion: A combination of IP plus systemic chemotherapy, CRS, and HIPEC was safe and resulted in good survival outcomes.
Full Text
https://www.sciencedirect.com/science/article/pii/S1091255X24004396
DOI
10.1016/j.gassur.2024.04.030
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyo Song(김효송) ORCID logo https://orcid.org/0000-0002-0625-9828
Jung, Min Kyu(정민규) ORCID logo https://orcid.org/0000-0001-8281-3387
Cho, Minah(조민아) ORCID logo https://orcid.org/0000-0003-3011-5813
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/201259
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