Effects of Neoadjuvant IntraperitonealSystemic Chemotherapy (Bidirectional Chemotherapy)‎ for the Treatment of Patients with Peritoneal Metastasis from Gastric Cancer

Abstract EN

Novel multidisciplinary treatment combined with neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS) and peritonectomy was developed.

Ninety-six patients were enrolled.

Peritoneal wash cytology was performed before and after NIPS through a port system.

Patients were treated with 60 mg/m2 of oral S-1 for 21 days, followed by a 1-week rest.

On days 1, 8, and 15, 30 mg/m2 of Taxotere and 30 mg/m2 of cisplatin with 500 mL of saline were introduced through the port.

NIPS is done 2 cycles before surgery.

Three weeks after NIPS, 82 patients were eligible to intend cytoreductive surgery (CRS) by gastrectomy + D2 dissection + periotnectomy to achieve complete cytoreduction.

Sixty-eight patients showed positice cytology before NIPS, and the positive cytology results became negative in 47 (69%) patients after NIPS.

Complete pathologic response on PC after NIPS was experienced in 30 (36.8%) patients.

Stage migration was experienced in 12 patients (14.6%).

Complete cytoreduction was achieved in 58 patients (70.7%).

By the multivariate analysis, complete cytoreduction and pathologic response became a significantly good survival.

However the high morbidity and mortality, stringent patient selection is important.

The best indications of the therapy are patients with good pathologic response and PCI≤6, which are supposed to be removed completely by peritonectomy.