Search

Background: A prospective randomized trial was conducted to compare the impact of systemic chemotherapy versus multi‐modality therapy (complete cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and systemic chemotherapy) on overall survival (OS) in patients with gastric carcinomatosis. Methods: Patients with measurable metastatic gastric adenocarcinoma involving the peritoneum, and resectable to “no evidence of disease” were randomized to gastrectomy, metastasectomy, HIPEC, and systemic FOLFOXIRI (GYMS arm) or FOLFOXIRI alone (SA arm). Results:Seventeenpatientswereenrolled(16evaluable);7of9patientsinthemulti‐modalityGYMSarmachievedcompletecytoreduction(CCR0). MedianOS was11.3monthsinthe GYMSarmand 4.3monthsintheSA arm.Fourpatientsin theGYMSarm survived>12months,2patients close to 2 years at last follow‐up, and 1 patient more than 4 years, with 2 of these patients still alive. No patient in the SA arm lived beyond 11 months. All patients surviving beyond 12 months in the surgery arm achieved complete cytoreduction and had an initial Peritoneal Cancer Index (PCI) of � 15. Conclusion: Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival. J. Surg. Oncol. 2014;110:275–284. 2014 Wiley Periodicals, Inc.

BACKGROUND Many patients with colorectal carcinoma develop unresectable metastases confined to the liver that remain the life-limiting component of disease despite best available systemic or regional chemotherapy. In the current study, the authors present their results using vascular isolation and perfusion of the liver for individuals with progressive, unresectable liver metastases from colorectal carcinoma that were refractory to both previous systemic and regional chemotherapy. METHODS Seven patients with refractory, progressive, unresectable colorectal carcinoma metastases confined to the liver underwent a 60-minute hyperthermic (39–40 °C) isolated hepatic perfusion (IHP) and were followed for toxicity, response, and survival. RESULTS There was no surgical- or treatment-related mortality; all patients experienced transient Grade 3–4 (according to National Cancer Institute common toxicity criteria) hepatic toxicity. At a median potential follow-up of 16 months, the overall objective radiographic response rate (all partial responses) was 71% (5 of 7 assessable patients). It is interesting to note that two patients who were treated with tumor necrosis factor (TNF) alone demonstrated no response to therapy compared with all five patients who were treated with melphalan and TNF (three patients) or melphalan alone (two patients). For the 5 patients who responded to treatment, the median duration of response was 10 months (range, 10–13 months) and in all 7 patients the mean overall survival was 19.7 months (range, 2–33 months), including 5 months and 7.5 months, respectively, for the 2 patients treated with TNF alone. CONCLUSIONS The results of the current study demonstrate that IHP using melphalan with or without TNF has significant antitumor activity in this patient population. IHP deserves continued clinical evaluation as a therapeutic modality for patients with unresectable colorectal carcinoma metastases to the liver. Cancer 2002;95:730–6. Published 2002 American Cancer Society. DOI 10.1002/cncr.10686