Hyperthermic intraperitoneal chemotherapy (HIPEC) plus systemic chemotherapy versus systemic chemotherapy alone in locally advanced gastric cancer after D2 radical resection: a randomized-controlled study.

BACKGROUND: Currently, there is a lack of an effective strategy for the prevention of peritoneal metastasis (PM) from locally advanced gastric cancer (AGC). This randomized-controlled study aimed to evaluate the outcome of D2 radical resection with hyperthermic intraperitoneal chemotherapy (HIPEC) plus systemic chemotherapy versus systemic chemotherapy alone in locally AGC patients. METHODS: All enrolled patients were randomly assigned to receive HIPEC plus systemic chemotherapy (HIPEC group) or systemic chemotherapy alone (non-HIPEC group) after radical gastrectomy. HIPEC was performed intraperitoneally with cisplatin (40 mg/m2) within 72 h after surgery, while systemic chemotherapy based on the SOX regimen (S-1 combined with oxaliplatin) was administered 4-6 weeks after radical surgery. Patterns of recurrence, adverse events, 3-year disease-free survival (DFS), and overall survival (OS) were analyzed. RESULTS: A total of 134 patients were enrolled in the present study. The 3-year DFS rate was 73.8% in the HIPEC group, which was significantly higher than that in the non-HIPEC group (61.2%, P = 0.031). The 3-year OS rate was 73.9% in the HIPEC group and 77.6% in the non-HIPEC group, with no significant difference (P = 0.737). PM was the most common distant metastasis in both groups. The occurrence rate of PM in the HIPEC group was statistically lower than that in the non-HIPEC group (20.9% vs. 40.3%, P = 0.015). Grade 3 or 4 adverse events occurred in 19 (14.2%) patients, and there was no significant difference between the two groups. CONCLUSION: Radical surgery followed by HIPEC combined with systemic chemotherapy is a safe and feasible strategy for locally AGC patients and could effectively improve DFS and reduce the occurrence of PM. However, more prospective randomized studies with a large sample size are warranted. TRIAL REGISTRATION: This study was registered with www.medresman.org.cn as ChiCTR2200055966 on 10/12/2016.

Expression of multidrug resistance-associated proteins and their relation to postoperative individualized chemotherapy in gastric cancer.

BACKGROUND: Adjuvant chemotherapy could reduce residual tumor cells and prevent relapse, however, not all patients are suitable for adjuvant chemotherapy. Screening appropriate patients based on molecular markers for individualized adjuvant chemotherapy is necessary. METHODS: Between June 2002 and June 2004, 119 patients who underwent radical gastrectomy were retrospectively analyzed. Some patients had adjuvant chemotherapy based on platinum and 5-FU for four to six cycles. Topoisomerase II (ToPo II) negative, multidrug resistance protein (MRP) positive and glutathione S-transferase π (GST-π) positive were regarded as three risk factors that may be associated with chemotherapy resistance and poor prognosis. Patients were divided into two groups: a high-risk group (≥2 risk factors) and a low-risk group (<2 risk factors), and tumor recurrence and patient survival time of the two groups were analyzed. RESULTS: The average recurrence time of the low-risk group was significantly longer than that of the high-risk group (21.29 ± 11.10 versus 15.16 ± 8.05 months, P < 0.01). The 3-year and 5-year survival rates of the high-risk group were 57.4% and 42.6%, however, it had no significant difference compared to 66.2% and 58.5% of the low-risk group (P >0.05). In the high-risk group, the 3-year survival rates of patients with/without chemotherapy were 62.1% and 52.0% and the 5-year survival rates were 44.8% and 40.0%, respectively, but the difference was not statistically significant (P > 0.05). In the low-risk group, the 3-year survival rates of patients with/without chemotherapy were 81.2% and 51.5%, and the 5-year survival rates were 71.9% and 45.5%, respectively, these differences were statistically significant (P < 0.05). CONCLUSIONS: Combined detection of the multidrug resistance (MDR)-related proteins ToPo II, MRP and GST-π may be prospectively valuable for postoperative individualized chemotherapy and in further predicting the outcomes of gastric cancer patients.

PCF Chemotherapy Combined with Surgical Treatment of Late Gastric Cancer.

BACKGROUND/AIMS: To investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of late-stage gastric cancer. METHODOLOGY: From July 2008 to February 2011, 72 cases of late-stage gastric cancer that could not be treated with R0 resection were treated prospectively. Patients received 2-4 cycles of paclitaxel plus cisplatin and 5-fluorouracil (PCF regimen) chemotherapy followed by cytoreductive surgery for the primary and metastatic tumors and another 2-4 cycles of PCF chemotherapy post-operatively. The treatment completion rate, patient tolerance and overall survival time were analyzed. RESULTS: There was one perioperative death. The overall response rate (complete and partial response) was 72.2%. Fifty patients (69.4%) completed chemotherapy and surgical resection as planned and 42 (58.3%) cases had R0 resection. The median survival time was 23.5 months (95% CI: 15.8-31.2 months). One-year and 2-year survival rates were 67.0% and 47.0%. The survival time of patients with surgical resection was much longer than that of the non-surgery group (30.2 vs. 8.9 months) (P < 0.01). The survival time of local advanced group was 30.3 months, and was significantly longer than 17.6 months of the distant metastasis group (P < 0.01); however, it had no significant difference compared to 28.2 months of the distant metastasis group with R0 resection. CONCLUSIONS: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for some late-stage gastric cancer patients.