N.N. Alexandrov National Cancer Center, Minsk, Belarus
Reutovich Mikhail Yu. ― PhD, Associate Professor, thoracic surgeon of gastroesophageal pathology department of N.N. Alexandrov National Cancer Center, SPIN-code 1738-0528, ORCID 0000-0001-7202-6902
Lesnoy, Minsk District, Republic of Belarus, 223040, tel.: +375 44 771-23-30, +375(17)389-95-32, e-mail: firstname.lastname@example.org
Relevance. Intraoperative hyperthermic intraoperitoneal chemotherapy (HIPEC) reduces the frequency and risk of carcinomatosis but is ineffective in preventing the development of distant lymphogematogenous metastases in gastric cancer (GC) patients due to its mainly locoregional effect. The latter fact warrants the need to combine it with systemic adjuvant chemotherapy (ACT). The purpose of this study is to evaluate the efficacy and practicability of such a combined modality approach.
Materials and methods. The study is based on the management of 133 patients with R. Borrmann III-IV type gastric cancer during the period from 2008 to 2016. Their treatment included (a) radical surgery in combination with HIPEC (cisplatin 50 mg/m2 + doxorubicin 50 mg/m2, 420С for 1 hour) ― HIPEC group; (b) radical surgery combined with HIPEC and ACT (oxaliplatin 100 mg/m2 on day 1 of each cycle and capecitabine 1,000 mg/m2 or tegafur 10-15 mg/kg twice daily on days 1-14 of each cycle with an interval of 7 days, a total of 8 cycles) ― HIPEC+ACT group; and (c) radical surgical treatment ― control group. Long-term results of treatment were evaluated by means of the Kaplan-Meier estimator, the Cox multi-factor model and a competing risks analysis.
Results. Compared with radical surgery alone, this combined modality approach to GC treatment reduced the cumulative incidence of metachronous peritoneal dissemination (pGray<0.001) and liver metastases (pGray=0.001). There was an increase in overall survival (рlog-rank=0.01), and cancer-specific survival (рlog-rank=0.008) free from disease progression (рlog-rank<0.001) and disease dissemination survival (рlog-rank<0.001) and also metastasis-free survival (рlog-rank<0.001).
Conclusion. The results of the study show potentialities of such a combined modality approach to the treatment of pT4a-bN0-3M0 gastric cancer achieved owing to the synergistic effect of radical surgery, HIPEC and adjuvant systemic chemotherapy.
Key words: gastric cancer, hyperthermic intraperitoneal chemotherapy, adjuvant systemic chemotherapy.