Abstract:
Objective To evaluate the clinical safety and efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) combined withneoadjuvant intraperitoneal and systemic chemotherapy (NIPS) and apatinib conversion therapy in patients with gastric cancer showing peritoneal metastasis (P1CY1).
Methods A retrospective analysis of 32 patients with gastric cancer confirmed to be P1CY1 disease after laparoscopic exploration from October 2017 to October 2018 was performed. All patients were treated with HIPEC combined with NIPS chemotherapy and apatinib conversion therapy. After six cycles of conversion therapy, laparoscopic exploration and evaluation were performed again, and the patients were further treated according to the evaluation results.
Results The treatment efficacy after conversion therapy was evaluated in the 32 patients. The objective response rate was 62.50%, and the disease control rate (DCR) was 90.63%. All patients underwent a second laparoscopic exploration. The peritoneal cancer index (PCI) score decreased in 24 cases (75.00%) and increased in eight cases (25.00%). The R0 resection rate was 18.75%. The median follow-up duration was 25.2 months; the median overall survival duration was 16.2 months 95% confidence interval (CI): 13.5-22.5; and the median progression-free survival (mPFS) duration was 14.9 months (95% CI: 11.4-20.3). Common adverse reactions mainly included bone marrow suppression, peripheral sensory neuropathy, gastrointestinal reactions, and oral mucositis; no toxicity-related deaths were recorded.
Conclusions HIPEC combined with NIPS chemotherapy and apatinib conversion therapy may improve the R0 resection rate and DCR of patients with gastric cancer showing peritoneal metastasis. Furthermore, the related adverse reactions were controllable. Thus, this is a safe and effective conversion treatment plan, and in-depth studies on this approach are warranted.
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