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World J Gastrointest Oncol. Feb 15, 2010; 2(2): 85-97
Published online Feb 15, 2010. doi: 10.4251/wjgo.v2.i2.85
Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer
Yutaka Yonemura, Ayman Elnemr, Yoshio Endou, Mitsumasa Hirano, Akiyoshi Mizumoto, Nobuyuki Takao, Masumi Ichinose, Masahiro Miura, Yan Li
Yutaka Yonemura, Ayman Elnemr, NPO Organization to Support Peritoneal Dissemination Treatment, Kishiwada, Osaka 596-0032, Japan
Yoshio Endou, Department of Experimental Therapeutics, Cancer Research Institute, Kanazawa University, Kanazawa 920-8640, Japan
Mitsumasa Hirano, Akiyoshi Mizumoto, Nobuyuki Takao, Masumi Ichinose, Department of Surgery, Kusatsu General Hospital, Shiga 525-8585, Japan
Masahiro Miura, Department of Anatomy, School of Medicine, Ooita University, Ooita 879-5593, Japan
Yan Li, Department of Oncology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China
Author contributions: All the authors contribute to this work; Yonemura Y wrote this work.
Correspondence to: Yutaka Yonemura, MD, PhD, NPO Organization to Support Peritoneal Dissemination Treatment, 1-26, Haruki-Moto-Machi, Kishiwada, Osaka 596-0032, Japan. y.yonemura@coda.ocn.ne.jp
Telephone: +81-72-4332131 Fax: +81-72-4332131
Received: July 2, 2009
Revised: December 5, 2009
Accepted: December 12, 2009
Published online: February 15, 2010
Abstract

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 efficacy 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 obtained in 15 (50%) out of 30 patients with PC. Thus, a significantly 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 benefit, 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.

Keywords: Gastric cancer; Peritoneal carcinomatosis; Chemotherapy