Peritoneal carcinomatosis (PC) is one of the most frequent manifestations of advanced gastric cancer (GC). The results of palliative chemotherapy for advanced GC remain unsatisfactory. PIPAC is a novel method of palliative treatment for PC and is minimally invasive delivery of cytostatics in form of finely dispersed aerosol.

OBJECTIVE

To study the results of systemic and pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with gastric cancer and synchronous peritoneal carcinomatosis.

MATERIAL AND METHODS

The protocol of bidirectional treatment with systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy for primary GC with synchronous PC as the first line of therapy was developed and implemented as a part of a Phase 2 study. The treatment began with 4 cycles of systemic chemotherapy (XELOX, FOLFOX, FLOT). PIPAC sessions were performed every 6—8 weeks with continuation of systemic therapy between PIPAC procedures. The treatment was continued until progression.

RESULTS

The method was applied in 226 patients (127 women, 99 men; median age, 49 y.o.) with GC and synchronous PC, who received 552 PIPAC sessions. Among them 69 (30.5%) patients had one PIPAC procedure, 139 (61.5%) — 2—4 procedures and 18 (7.9%) had 5 and more procedures. Median initial PCI was 10.3. More than 90% of cases had Lauren’s diffuse type. The most common complications were abdominal pain and fever. Postoperative mortality was 0.036% (bowel perforation). Peritoneal Regression Grading Score was estimated in 128 patients, who received 2 and more procedures. Complete and major response (PRGS 1 and 2) was observed in 67% of cases. For 19 patients with low PCI surgery (conversion) was performed. The median survival for all patients was 15 months, 1-year survival — 66.2%. The poor prognostic factors were young age (<40 y.o.), high initial PCI (>18), ascites, progression on systemic chemotherapy before PIPAC.

CONCLUSIONS

Bidirectional treatment with systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy is safe and effective palliative approach for GC with synchronous PC. The method induces objective tumor regression in 67% of patients and demonstrates a promising survival in GC with PC.