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HIPEC well tolerated in gastric carcinomas
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Patients with gastric cancer and positive cytology or low-volume carcinomatosis experienced few postoperative complications after receiving laparoscopic preoperative hyperthermic intraperitoneal chemoperfusion, also called HIPEC, according to a clinical trial presented at the Society of Surgical Oncology Annual Cancer Symposium.
“One strength with this approach is that it allows for repeated treatment with HIPEC,” Brian D. Badgwell, MD, MS, associate professor of surgery at The University of Texas MD Anderson Cancer Center, told HemOnc Today. “We would never expect a single dose of systemic chemotherapy to be effective, and HIPEC in gastric cancer may not be that different.”
HIPEC is a procedure — introduced in the late 1980s — that delivers highly concentrated, heated chemotherapy treatment directly to the abdomen.
Badgwell and colleagues evaluated the effectiveness of HIPEC in a neoadjuvant fashion through a minimally invasive approach without cytoreduction for patients with gastric cancer and positive cytology for low-volume carcinomatosis.
In the trial, 19 patients (median age, 51 years; range, 29-69) with gastric or gastroesophageal adenocarcinoma and positive peritoneal cytology or radiologically occult carcinomatosis who had completed systemic chemotherapy received laparoscopic HIPEC with 30 mg mitomycin C and 200 mg cisplatin. Patients whose peritoneal disease resolved could continue to gastrectomy.
Median follow-up was 18.9 months from the date of diagnosis of metastatic disease.
OS served as the primary endpoint; postoperative complications and the rate of gastrectomy served as secondary endpoints.
Before enrollment, all patients had been treated with a median of eight cycles (range, 3-12) of systemic chemotherapy. Additionally, 14 patients had been treated with chemoradiation therapy.
During the study, 19 patients received 37 laparoscopic HIPEC procedures.
Six patients had positive cytology only, and 13 had carcinomatosis.
The major morbidity rate after HIPEC was 3% with zero deaths. Median length of hospital stay was 3 days (range, 3-6), and five patients continued to gastrectomy.
Median OS from the date of diagnosis of metastatic disease was 34.7 months. Median OS from the first laparoscopic HIPEC was 28.1 months.
“We have demonstrated feasibility with this approach, which could allow for HIPEC to be studied during repeated treatments,” Badgwell said. “I am hoping to find other investigators enthusiastic about this approach to put together a multi-institutional collaboration to determine the survival benefit.”– by Chuck Gormley
Reference:
Badgwell BD, et al. Abstract 1. Presented at: Society of Surgical Oncology’s Annual Cancer Symposium 2017; March 15-18, 2017; Seattle.
Disclosure: Researchers report no relevant financial disclosures.