Dados do Trabalho

Título

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and gastric cancer: A systematic review of the indications and prognosis of this alternative treatment for patients with peritoneal carcinomatosis

Introdução

Historically, the survival rate for patients with Gastric Cancer and peritoneal carcinomatosis has been poor, ranging from 2.2 to 8.8 months and no survival at 5 years. Peritoneal carcinomatosis (PC) is considered a variant of the systemic spread of disease, and the standard recommendation for patients with gastric cancer and PC is systemic chemotherapy or palliative supportive care. However ,new strategies are being developed to improve the survival, complications and outcomes of gastric cancer patients with PC.

Objetivo

Evaluate the benefit of HIPEC in patients with Gastric Cancer and Peritoneal Carcinomatosis.

Método

This systematic review of published literature was carried out according to a predefined protocol, studies published in the last 5 years were identified through an electronic search of the US National Library of Medicine (MEDLINE), strategy used: (HIPEC) AND (Gastric Cancer). The title and abstract of each study was examined for relevance with full text being obtained for all potentially relevant studies. Studies were included regardless of design, with both trials and observational studies.

Resultados

Systemic chemotherapy alone has had disappointing results, therefore, not a recommended management plan for patients with peritoneal carcinomatosis. The majority of the literature regarding the benefit of Cytoreduction (CR) and HIPEC in gastric cancer has included patients with macroscopic peritoneal disease and demonstrated therapeutic benefit (survival and disease control) in patients with a PCI ≤12, since survival remains poor, even with a complete cytoreduction when PCI is higher than 12. For a neoadjuvant approach, HIPEC should only be considered in patients with low-volume peritoneal metastasis (PCI ≤6) or symptomatic ascites, once there's only proof of benefit in those cases and more clinical trials are needed to establish this approach. Still no studies have evaluated the effect of HIPEC on cytology-only positive PC, and more studies are needed to prove its role as an adjuvant/prophylactic setting.

Conclusão

The importance of patient selection for CR and HIPEC is fundamental and cannot be overstated, since a large number of patients with gastric peritoneal metastases will not benefit from it because of disease extension. However, CR and HIPEC have promising results in well selected patients with peritoneal carcinomatosis of gastric origin, significantly improving survival, quality of life and life expectancy.