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Optimizing outcomes for patients with gastric cancer peritoneal carcinomatosis

World Journal of Gastrointestinal Oncology 2018年第10期10卷 282-289页

作者： Jennifer L Leiting Travis E Grotz Division of Hepatobiliary and Pancreas Surgery Mayo Clinic

Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival out-comes. Positive peritoneal cytology similarly worsens the survival of patients with gastric cancer and treatment options for these patients have been limited. Recent ad-vances in multimodality treatment regimens have led to innovative ways to care for and treat patients with this disease burden. One of these advances has been to use neoadjuvant therapy to try and convert patients with positivecytologyorlow-volume PC to negative cytolo-gy with no evidence of active peritoneal disease.These strategies include the use of neoadjuvant systemic chemotherapy alone,using neoadjuvant laparoscopic heated intraper itoneal chemotherapy(NLHIPEC)after systemic chemotherapy,or using neoadjuvant intra-peritoneal and systemic chemother apy(NIPS)in a bi-dir ectional manner. For patients with higher volume PC,cytoreductive surgery (CRS) and hyperthermic intrape-ritoneal chemotherapy(HIPEC)have been mainstays of treatment. When used together, CRS and HIPEC can improve overall outcomes in properly selected patients,but overall survival outcomes remain unacceptably low.The extent of peritoneal disease, commonly measured by the peritoneal carcinomatosis index (PCI), and the com-pleteness of cytor eduction,has been shown to greatly impact outcomes in patients undergoing CRS and HIPEC.The uses of NLHIPEC and NLHIPEC plus NIPS have both been shown to decrease the PCI and thus increase the opportunity for complete cytoreduction. Newer therapies like pressurized intraperitoneal aerosol chemother apy and immunotherapy, such as catumaxomab, along with improved systemic chemotherapeutic regimens, are being explored with great interest.There is exciting progress being made in the management of PC from gastric can-cer and its’ treatment is no longer futile.

关键词： Peritoneal carcinomatosis index Peritoneal carcinomatosis Gastric cancer Cytoreductive surgery Heated intraperitoneal chemotherapy Neoadjuvant intraperitoneal and systemic chemotherapy

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Peritoneal carcinomatosis of colorectal origin

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World Journal of Gastrointestinal Oncology 2010年第2期2卷 98-101页

作者： Antonio Macrì Edoardo Saladino Vincenzo Bartolo Vincenzo Adamo Giuseppe Altavilla Epifanio Mondello Giovanni Condemi Angelo Sinardi Ciro Famulari University of Messina Department of Human PathologyGeneral Surgery Unit University of Messina Department of Human PathologyMedical Oncology Unit University of Messina Anesthesiology Unit Ospedali Riuniti della Locride Hospital of SidernoMedical Oncology Unit

Peritoneal carcinomatosis is,after liver metastases,the second most frequent cause of death in colorectal cancer patients and at the present time,is commonly inserted and treated as a stage Ⅳ tumour.Because there is no published data that outlines the impact of new therapeutic regimens on survival of patients with peritoneal surface diffusion,the story of carcinomatosis can be rewritten in light of a new aggressive approach based on the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.Also if these treatment perhaps allow to obtain better results than standard therapies,we suggest,that a large prospective randomised control trial is needed to compare long-term and progression-free survival under the best available systemic therapy with or without cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

关键词： Colorectal cancer Peritoneal carcinomatosis Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy

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Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

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World Journal of Gastroenterology 2017年第3期23卷 377-381页

作者： Delia Cortes-Guiral Dominique Elias Pedro Antonio Cascales-Campos Alfredo Badía Yébenes Ismael Guijo Castellano Ana Isabel León Carbonero JoséIgnacio Martín Valadés Jesus Garcia-Foncillas Damian Garcia-Olmo Department of General Surgery(Peritoneal Surface Surgical Oncolongy) Fundación Jiménez Díaz Hospital28050 MadridSpain Department of Surgical Oncology Institut Gustave Roussy94805 VillejuifCédexFrance Department of General Surgery(Peritoneal Surface Surgical Oncolongy) Virgen de la Arrixaca30120 MurciaSpain Department of Medical Oncology Fundación Jiménez Díaz Hospital28050 MadridSpain

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

关键词： Second-look surgery High-risk patients Peritoneal carcinomatosis Hyperthermic intraperitoneal chemotherapy Colo-rectal cancer

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Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer

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World Journal of Gastrointestinal Oncology 2010年第2期2卷 85-97页

作者： Yutaka Yonemura Ayman Elnemr Yoshio Endou Mitsumasa Hirano Akiyoshi Mizumoto Nobuyuki Takao Masumi Ichinose Masahiro Miura NPO Organization to Support Peritoneal Dissemination Treatment KishiwadaOsaka 596-0032Japan Department of Experimental Therapeutics Cancer Research InstituteKanazawa University Department of Surgery Kusatsu General Hospital Department of Anatomy School of Medicine Ooita University

There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer.A novel multidisciplinary treatment combining bidirectional chemotherapy [neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)],peritonectomy,hyperthermic intraperitoneal chemoperfusion (HIPEC) and early postoperative intraperitoneal chemotherapy has been developed.In this article,we assess the indications,safety and eff icacy of this treatment,review the relevant studies and introduce our experiences.The aims of NIPS are stage reduction,the eradication of peritoneal free cancer cells,and an increased incidence of complete cytoreduction (CC-0) for PC.A complete response after NIPS was ob-tained in 15 (50%) out of 30 patients with PC.Thus,a signif icantly high incidence of CC-0 can be obtained in patients with a peritoneal cancer index (PCI) ≤ 6.Using a multivariate analysis to examine the survival benef it,CC-0 and NIPS are identified as significant indicators of a good outcome.However,the high morbidity and mortality rates associated with peritonectomy and perioperative chemotherapy make stringent patient selection important.The best indications for multidisciplinary therapy are localized PC (PCI≤6) from resectable gastric cancer that can be completely removed during a peritonectomy.NIPS and complete cytoreduction are essential treatment modalities for improving the survival of patients with PC from gastric cancer.

关键词： Gastric cancer Peritoneal carcinomatosis Chemotherapy

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Leptomeningeal carcinomatosis:an unusual cause of headache in bronchial carcinoma

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Chinese Medical Journal 1999年第1期 87-89页

Ｗｅｒｅｐｏｒｔｔｈｅｃｌｉｎｉｃｏｒａｄｉｏｌｏｇｉｃａｌｆｅａｔｕｒｅｓｏｆａｎｕｎｃｏｍｍｏｎｃａｕｓｅｏｆｓｅｖｅｒｅｉｎｔｒａｃｔａｂｌｅｈｅａｄａｃｈｅｉｎａ３５ｙｅａｒｏｌｄｗｏｍａｎｗｉｔｈｎｏｎ... 详细信息

Ｗｅｒｅｐｏｒｔｔｈｅｃｌｉｎｉｃｏｒａｄｉｏｌｏｇｉｃａｌｆｅａｔｕｒｅｓｏｆａｎｕｎｃｏｍｍｏｎｃａｕｓｅｏｆｓｅｖｅｒｅｉｎｔｒａｃｔａｂｌｅｈｅａｄａｃｈｅｉｎａ３５ｙｅａｒｏｌｄｗｏｍａｎｗｉｔｈｎｏｎｓｍａｌｃｅｌｌｕｎｇｃａｎｃ...

关键词： cause headache carcinomatosis unusual bronchial Leptomeningeal

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Leptomeningeal carcinomatosis as the initial manifestation of gastric adenocarcinoma:A case report

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World Journal of Gastroenterology 2014年第8期20卷 2120-2126页

作者： Jian-Wen Guo Xiao-Tian Zhang Xiao-Sheng Chen Xin-Chun Zhang Guang-Juan Zheng Bei-Ping Zhang Ye-Feng Cai Brain Centre Guangdong Province Hospital of Traditional Chinese MedicineGuangzhou University of Traditional Chinese Medicine Department of GI Oncology Peking University Cancer Hospital and School of Oncology

Leptomeningeal involvement is usually reported as a secondary event in advanced gastric carcinoma.Leptomeningeal carcinomatosis(LMC),as the initial manifestation of asymptomatic gastric cancer,is exceedingly rare with only a few cases reported in recent years.The presenting neurologic symptoms include headache,vomiting and seizures and are usually clinically atypical.The diagnosis of LMC is made via identification of malignant cells that originate from epithelial cells in the cerebrospinal fluid by cytological examination and provides cues to track the primary tumor.Endoscopic examinations are crucial to confirm the presence of gastric cancer,and imaging studies,especially gadolinium-enhanced magnetic resonance imaging of the brain,are sometimes helpful in diagnosis.Thus far,there is no standard therapy for LMC,and despite all measures,the prognosis of the condition is extremely poor.Here,we report on the clinical features and diagnostic procedures for a patient with occult gastric cancer with Bormann typeⅠmacroscopic appearance and poor differentiation in pathology,who presented with LMC-induced neurological symptoms as the initial clinical manifestation.Additionally,we review the similar cases reported over the past years,making comparison among cases in order to provide more information for the future diagnosis.

关键词： Meningeal carcinomatosis Stomach neoplasms Endosco

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Recent aspects for disseminated carcinomatosis of the bone marrow associated with gastric cancer: What has been done for the past, and what will be needed in future?

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World Journal of Gastroenterology 2015年第43期21卷 12249-12260页

作者： Haruo Iguchi Department of Gastroenterology Shikoku Cancer Center

Disseminated carcinomatosis of the bone marrow is characterized by widespread bone metastasis(bone marrow infiltration) from solid tumors with hematological disorders coexisted. This disease is frequently complicated with gastric cancer among solid tumors although its incidence is very rare. In recent years,technological innovations in diagnosis and treatment for cancer have remarkably improved,which made survival rates of various cancers prolonged. Prognosis of disseminated carcinomatosis of the bone marrow associated with gastric cancer,however,is still poor(less than a year),possibly because this disease has not been given attention due to low incidence. In this review,I summarize the results obtained for the past,and propose ways to improve the prognosis of this disease.

关键词： Disseminated carcinomatosis of the bone marrow Gas

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Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum

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World Journal of Gastroenterology 2016年第34期22卷 7692-7707页

作者： Lieselotte Lemoine Paul Sugarbaker Kurt Van der Speeten Department of Medicine and Life Sciences Hasselt University3500 Hasselt Belglum Department of Surgical Oncology Ziekenhuis Oost-Limburg 3600 Genk Belgium Washington Cancer Institute Washington Hospital Center Washington DC 20010 United States

Colorectal cancer(CRC) is the third most common cancer and the fourth most common cause of cancerrelated death worldwide. Besides the lymphatic and haematogenous routes of dissemination,CRC frequently gives rise to transcoelomic spread of tumor cells in the peritoneal cavity,which ultimately leads to peritoneal carcinomatosis(PC). PC is associated with a poor prognosis and bad quality of life for these patients in their terminal stages of disease. A loco-regional treatment modality for PC combining cytoreductive surgery and hyperthermic intraperitoneal peroperative chemotherapy has resulted in promising clinical results. However,this novel approach is associated with significant morbidity and mortality. A comprehensive understanding of the molecular events involved in peritoneal disease spread is paramount in avoiding unnecessary toxicity. The emergence of PC is the result of a molecular crosstalk between cancer cells and host elements,involving several well-defined steps,together known as the peritoneal metastatic cascade. Individual or clumps of tumor cells detach from the primary tumor,gain access to the peritoneal cavity and become susceptible to the regular peritoneal transport. They attach to the distant peritoneum,subsequently invade the subperitoneal space,where angiogenesis sustains proliferation and enables further metastatic growth. These molecular events are not isolated events but rather a continuous and interdependent process. In this manuscript,we review current data regarding the molecular mechanisms underlying the development of colorectal PC,with a special focus on the peritoneum and the role of the surgeon in peritoneal disease spread.

关键词： Peritoneal carcinomatosis Pathophysiology Peritoneal metastatic cascade Cytoreductive surgery Peritoneum Hyperthermic intraperitoneal peroperative chemotherapy

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Current treatment options for colon cancer peritoneal carcinomatosis

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World Journal of Gastroenterology 2014年第35期20卷 12493-12500页

作者： Tomoyoshi Aoyagi Krista P Terracina Ali Raza Kazuaki Takabe Division of Surgical Oncology Department of SurgeryVirginia Commonwealth University School of Medicine Division of Surgical Oncology Department of SurgeryVirginia Commonwealth University School of MedicineRichmond

Peritoneal carcinomatosis(PC),the dissemination of cancer cells throughout the lining of the abdominal cavity,is the second most common presentation of colon cancer distant metastasis.Despite remarkable advances in cytotoxic chemotherapy and targeted therapy for colon cancer over the last 15 years,it has been repeatedly shown that these therapies remain ineffective for colon cancer PC.Recently,there has been a rapid accumulation of reports that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy(CRS-HIPEC) prolongs the life of colon cancer PC patients.Here,we will review the clinical presentation,the mechanisms of disease progression,and current treatment options for colon cancer PC,with a focus on the benefits and limitations of CRSHIPEC.

关键词： Cancer Colorectal carcinomatosis Peri-toneal Hyper

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Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal carcinomatosis: Is HIPEC the Only Answer?

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Modern Chemotherapy 2014年第2期3卷 11-19页

作者： Ka-On Lam Betty Tsz-Ting Law Simon Ying-Kit Law Dora Lai-Wan Kwong Department of Clinical Oncology LKS Faculty of Medicine The University of Hong Kong Hong Kong China Department of Surgery LKS Faculty of Medicine The University of Hong Kong Hong Kong China

Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 - 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.

关键词： Gastric Cancer Peritoneal carcinomatosis Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Neoadjuvant Intraperitoneal/Systemic Chemotherapy (NIPS) Cytoreductive Surgery

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