The role of intraperitoneal chemotherapy in the treatment of patients with advanced gastric cancer.

AIM To review the published literature analyzing the role of intraperitoneal chemotherapy in gastric cancer. MATERIAL OF STUDY Peritoneal dissemination is a well recognized and important component of disease progression in gastric cancer. Considering that involvement of the peritoneal surface can be anticipated in a large number of patients who present with an advanced gastric cancer, research efforts have been focusing not only on treatment of established peritoneal disease but also on prevention of peritoneal dissemination during surgery for primary gastric cancer. RESULTS The pharmacologic rationale for intraperitoneal chemotherapy has been well studied. The role and results of HIPEC combined with cytoreductive surgery for patients with established carcinomatosis from gastric cancer has been reported by several groups and appears to be a promising modality for a selected group of patients with limited disease. DISCUSSION A possible approach to patients with carcinomatosis from gastric cancer includes the use of neoadjuvant bidirectional chemotherapy (intraperitoneal and intravenous or NIPS) with subsequent cytoreduction and HIPEC for patients with a positive response to NIPS. Even more importantly, in several randomized studies and one meta-analysis, the use of intraperitoneal chemotherapy was beneficial in patients undergoing surgery for a primary, advanced gastric cancer. CONCLUSION It appears that a significant amount of data has accumulated regarding the KEY optimal use of cytoreductive surgery and intraperitoneal chemotherapy in gastric cancer. An algorithm for the management of gastric cancer patients incorporating these treatment modalities can be implemented.