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Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: Results of the GYMSSA trial
Author(s) -
Rudloff Udo,
Langan Russell C.,
Mullinax John E.,
Beane Joal D.,
Steinberg Seth M.,
Beresnev Tatiana,
Webb Carole C.,
Walker Melissa,
Toomey Mary Ann,
Schrump David,
Pandalai Prakash,
Stojadinovic Alexander,
Avital Itzhak
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23633
Subject(s) - medicine , hyperthermic intraperitoneal chemotherapy , surgery , chemotherapy , peritoneal carcinomatosis , gastrectomy , metastasectomy , conventional pci , cytoreductive surgery , cancer , metastasis , colorectal cancer , ovarian cancer , myocardial infarction
Background A prospective randomized trial was conducted to compare the impact of systemic chemotherapy versus multi‐modality therapy (complete cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and systemic chemotherapy) on overall survival (OS) in patients with gastric carcinomatosis. Methods Patients with measurable metastatic gastric adenocarcinoma involving the peritoneum, and resectable to “no evidence of disease” were randomized to gastrectomy, metastasectomy, HIPEC, and systemic FOLFOXIRI (GYMS arm) or FOLFOXIRI alone (SA arm). Results Seventeen patients were enrolled (16 evaluable); 7 of 9 patients in the multi‐modality GYMS arm achieved complete cytoreduction (CCR0). Median OS was 11.3 months in the GYMS arm and 4.3 months in the SA arm. Four patients in the GYMS arm survived >12 months, 2 patients close to 2 years at last follow‐up, and 1 patient more than 4 years, with 2 of these patients still alive. No patient in the SA arm lived beyond 11 months. All patients surviving beyond 12 months in the surgery arm achieved complete cytoreduction and had an initial Peritoneal Cancer Index (PCI) of ≤15. Conclusion Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival. J. Surg. Oncol. 2014 110:275–284 . © 2014 Wiley Periodicals, Inc.