Y. Yonemura et al., EFFECTS OF INTRAOPERATIVE CHEMOHYPERTHERMIA IN PATIENTS WITH GASTRIC-CANCER WITH PERITONEAL DISSEMINATION, Surgery, 119(4), 1996, pp. 437-444
Background. The most common cause of noncurative resection and recurre
nce in gastric cancer is peritoneal seeding. However, the results of t
reatment of peritoneal dissemination with chemotherapy have been. poor
with 5-year survival rates of 0%. Methods. A new in vitro thermochemo
sensitivity test was performed on gastric cancer cells obtained from 1
9 surgically resected specimens by using tetrazolium-based colorimetri
c assay (MTT assay). A novel treatment of the intraoperative chemohype
rthermia was undertaken in. 83 patients with gastric cancer with perit
oneal dissemination. After aggressive resection of primary tumor, lymp
h nodes, and peritoneal metastases, warned saline solution containing
mitomycin. C 30 mg, etoposide 150 mg, and cisplatin 300 mg was introdu
ced into the peritoneal cavity via a closed circuit continuous hyperth
ermic peritoneal perfusion (CHPP) for 60 minutes to keep the abdominal
temperature at 42 degrees to 43 degrees C by means of a heat exchange
mechanism. Results. The in vitro thermochemosensitivity test showed t
hat 43 degrees C enhanced the cytotoxic effects on. gastric cancer cel
ls under clinically achievable drug concentrations. During CHPP, drug
concentrations of cisplatin, mitomycin C, and etoposide in the perfusa
te remained statistically higher than in the peripheral venous circula
tion. Among 43 evaluable patients with residual peritoneal seeding, ei
ght (19%) and nine (21%) exhibited complete response and partial respo
nse, respectively. The overall 1-and 5-year survival rates were 43% an
d 11%, respectively. Patients who underwent complete resection survive
d significantly longer than those with residual disease, and those wit
h complete response had a significantly better prognosis than did thos
e with partial response or nonresponders. One-year survival rates of p
atients with complete response, partial response, and nonresponders we
re 88%, 27%, and 22%, respectively. Five patients survived longer than
5 years. Conclusions. Our triple treatment combining surgery and CHPP
is an effective therapy for selected patients with gastric cancer wit
h peritoneal dissemination.