CYTOREDUCTIVE SURGERY AND SANDWICH THERAPY WITH CHEMOHYPERTHERMIC PERITONEAL PERFUSION AND INTRAAORTIC CHEMOTHERAPY FOR PERITONEAL DISSEMINATION IN GASTRIC-CANCER
T. Fujimura et al., CYTOREDUCTIVE SURGERY AND SANDWICH THERAPY WITH CHEMOHYPERTHERMIC PERITONEAL PERFUSION AND INTRAAORTIC CHEMOTHERAPY FOR PERITONEAL DISSEMINATION IN GASTRIC-CANCER, Oncology Reports, 3(3), 1996, pp. 513-517
Cytoreductive resection (RST), chemohyperthermic peritoneal perfusion
(CHPP) and/or intra-aortic chemotherapy (IA-chemo) were performed for
peritoneal dissemination in gastric cancer. Ninety-six patients with p
eritoneal dissemination were grouped into tubercular (TB), 40; nodular
(ND), 31; diffuse (DF) type, 19; and others, 6, respectively, by the
gross findings. Sixty-three patients underwent RST. Fifty-nine patient
s received CHPP by 10-liter heated saline. Thirty patients underwent i
ntra-aortic catheterization for the IA-chemo. The 1-year and 2-year su
rvival rate (1-ysr and 2-ysr) of the RST(+) group were 47% and 10% sig
nificantly greater than the 9% and 0% of the RST(-) group (p<0.001). T
he 1-ysr and 2-ysr of the CHPP(+) group were 37% and 11% significantly
greater than the 27% and 0% of the CHPP(-) group (p=0.04). In the TB
type the 1-ysr and 2-ysr of the former was 43% and 8% significantly gr
eater than the 15% and 0% of the latter (p=0.04). But there was no sig
nificant difference in survival time between the CHPP(+) and the CHPP(
-) group in the ND type (p=0.22) or in the DF type (p=0.42). The 1-ysr
and 2-ysr of the IA-chemo(+) group were 49% and 19% significantly gre
ater than the 27% and 2% of the IA-chemo(-) group (p<0.01). In the DF
type the 1-ysr and 2-ysr of the former was 50% and 33% significantly g
reater than the 8% and 0% of the latter (p=0.02). However, there was n
o significant difference in survival time between the IA-chemo(+) and
the IA-chemo(-) group in the TB type (p=0.06) or in the ND type (p=0.5
0). Moreover, the effect of the combination therapy of CHPP and IA-che
mo (the sandwich therapy, SDW) were examined. The 1-ysr and 2-ysr of t
he SDW(+) group were 49% and 22% significantly greater than the 24% an
d 0% of the SDW(-) group (p=0.002). The sandwich therapy should be per
formed in addition to cytoreductive surgery for improvement of prognos
is in the patient with intractable peritoneal dissemination.