TITLE:
Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Carcinomatosis: Is HIPEC the Only Answer?
AUTHORS:
Ka-On Lam, Betty Tsz-Ting Law, Simon Ying-Kit Law, Dora Lai-Wan Kwong
KEYWORDS:
Gastric Cancer, Peritoneal Carcinomatosis, Hyperthermic Intraperitoneal Chemotherapy (HIPEC), Neoadjuvant Intraperitoneal/Systemic Chemotherapy (NIPS), Cytoreductive Surgery
JOURNAL NAME:
Modern Chemotherapy,
Vol.3 No.2,
January
4,
2015
ABSTRACT:
Gastric cancer with peritoneal carcinomatosis is notorious for its dismal
prognosis. While the pathophysiology of peritoneal dissemination is still
controversial, the rapid downhill course is universal. Patients usually suffer
abdominal distension, intestinal obstruction and various complications before
they succumb after a median of 3 - 6 months. Although not adopted in most international
treatment guidelines, intraperitoneal chemotherapy has growing evidence
compared with conventional systemic chemotherapy for the treatment of
peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic
intraperitoneal chemotherapy is well-established for clinical benefit but is
technically demanding with substantial treatment-related morbidities and
mortality. On the other hand, normothermic intraperitoneal chemotherapy in the
form of bidirectional neoadjuvant treatment is promising with various newer
chemotherapeutic agents. Regardless of the treatment technique applied, the
essential element of success is meticulous patient selection and availability
of expertise. Future direction is along the line of personalized treatment with
the application of translational science.