Yutaka Yonemura1,2,3,4, Haruaki Ishibashi5, Masamitu Hirano6, Akiyoshi Mizumoto6, Kazuyosi Takeshita5, Kousuke Noguchi6, Nobuyuki Takao6, Masumi Ichinose6, Yang Liu7,5, Yan Li8. 1. NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan. y.yonemura@coda.ocn.ne.jp. 2. Department of Regional Cancer Therapies, Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Japan. y.yonemura@coda.ocn.ne.jp. 3. Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan. y.yonemura@coda.ocn.ne.jp. 4. Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan. y.yonemura@coda.ocn.ne.jp. 5. Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan. 6. Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan. 7. NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan. 8. Department of Peritoneal Surface Oncology, Beijing Shijitan Hospital of Capital Medical University, Beijing, China.
Abstract
BACKGROUND: The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated. MATERIALS AND METHODS: In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied. RESULTS: In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients. CONCLUSIONS: NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.
BACKGROUND: The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated. MATERIALS AND METHODS: In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied. RESULTS: In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients. CONCLUSIONS: NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.
Authors: Beate Rau; Olivier Glehen; Paul H Sugarbaker; M Haroon A Choudry; Yukata Yonemura; David L Morris; Sebastian Stintzing; David P Ryan Journal: Visc Med Date: 2022-03-08