Systemic Chemotherapy using FLOT - Regimen Combined with Cytoreductive Surgery plus HIPEC for Treatment of Peritoneal Metastasized Gastric Cancer

摘要

Background/Aims. The aim was to evaluate the feasibility and the effectiveness of neoadjuvant systemic chemotherapy using FLOT - protocol followed by cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC) followed by systemic chemo-therapyand in patients with peritoneal carcinomato-sis (PC) from gastric cancer. Methodology: Twenty six (median age 53 years, range 39 - 71) were scheduled for three cycles of neoadjuvant systemic chemotherapy using bi-weekly FLOT - protocol followed by CRS + HIPEC. Thereafter 3 additional cycles of FLOT were given. During HIPEC in Colliseum technique Oxaliplatin was given in a dosage of 200 mg/m2 and Docetaxel in a dosage of 80 mg/m2. Results: All patients underwent cytoreduc-tive surgery plus HIPEC. Peritoneal Cancer index was > 15 in 3 cases only. Complete resection could be carried out in all cases (CC-0 18, CC-l 8). Postoperative complication rate was 23% with no mortality within 30 days. Anastomotic leakage rate was 3.2 %. Overall survival was 19.0 months with a 2-year survival rate 38 %. Regression analysis demonstrated a Peritoneal Cancer Index PCI > 12 as negative factor for survival. Conclusion: Neoadjuvant chemotherapy using FLOT - protocol followed by CRS + HIPEC seems to be associated with prolonged OS in patients with peritoneal carcinomatosis from gastric cancer. This treatment is not recommended for patients with extensive peritoneal involvement and PCI > 12.