J Gastric Cancer.  2014 Jun;14(2):117-122.

Initial Clinical Experience with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Signet-Ring Cell Gastric Cancer with Peritoneal Metastases

• Konigsrainer I
• Horvath P
• Struller F
• Konigsrainer A
• Beckert S

Abstract

PURPOSE
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in select patients with gastric cancer and peritoneal metastases. It remains unclear, however, whether this multimodal treatment protocol is also beneficial for signet-ring cell gastric cancer (SRC) patients with peritoneal metastases.
MATERIALS AND METHODS
Clinical data of patients scheduled for upfront systemic chemotherapy consisting of 5-FU (2,600 mg/m2), folinic acid (200 mg/m2), docetaxel (50 mg/m2), and oxaliplatin (85 mg/m2) followed by CRS and HIPEC using cisplatin (50 mg/m2) at the Comprehensive Cancer Center, University Hospital Tubingen, Germany were retrospectively analyzed.
RESULTS
Eighteen consecutive patients for whom irresectability has been ruled out by a computed tomography scan were enrolled. However, complete cytoreduction could only be achieved in 72% of patients. When categorizing patients with respect to the completeness of cytoreduction, we found no difference between both groups considering tumor- or patient-related factors. The overall complication rate following complete cytoreduction and HIPEC was 46%. Within a median follow-up of 6.6 (0.5~31) months, the median survival for CRS and HIPEC patients was 8.9 months as opposed to 1.1 months for patients where complete cytoreduction could not be achieved. Following complete cytoreduction and HIPEC, progression-free survival was 6.2 months.
CONCLUSIONS
In SRC with peritoneal metastases, the prognosis appears to remain poor irrespective of complete CRS and HIPEC. Moreover, complete cytoreduction could not be achieved in a considerable percentage of patients. In SRC, CRS and HIPEC should be restricted to highly selective patients in order to avoid exploratory laparotomy.

Keyword

Peritoneal surface malignancy; Hyperthermic intraperitoneal chemotherapy; Stomach neoplasms

MeSH Terms

Cisplatin
Combined Modality Therapy
Disease-Free Survival
Drug Therapy*
Fluorouracil
Follow-Up Studies
Germany
Humans
Laparotomy
Leucovorin
Neoplasm Metastasis*
Prognosis
Retrospective Studies
Stomach Neoplasms*
Cisplatin
Fluorouracil
Leucovorin

Figure

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  Fig. 1 Cumulative survival comparing patients following complete cytoreduction and HIPEC (HIPEC = 1) and explorative laparotomy (HIPEC = 0). HIPEC = hyperthermic intraperitonealchemotherapy.

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  Fig. 2 Progression-free survival following complete cytoreductive surgery and hyperthermic intraperitonealchemotherapy.

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