674P - Hyperthermic intraperitoneal chemoterapy (HIPEC) and cytoreductive surgery for synchronous peritoneal carcinomatosis (PC) from gastric cancer (GC)...

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer agents
Gastric Cancer
Surgical oncology
Therapy
Biological therapy
Radiation oncology
Presenter Marie-Laure Amram
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors M. Amram1, D. Benamran2, G. Wirth2, A.D. Roth1, O. Huber2
  • 1Division Of Oncology, Geneva University Hospital, 1211 - Geneva/CH
  • 2Department Of Surgery, Geneva University Hospital, 1211 - Geneva/CH

Abstract

Aim

The aim of this retrospective study was to asses the early- and long-term outcomes of patients undergoing neoadjuvant chemotherapy followed by combined cytoreductive surgery and HIPEC for PC arising from GC.

Methods

We reviewed all cases of patients treated for PC from GC (any histology) in our institution from 2008 to 2012. Exclusion criteria were presence of visceral or extra-abddominal metatasis, poor performance status (ECOG > 2) and PCI score (Sugerbaker's Peritoneal Cancer Index) > 12 at diagnostic pre-treatment laparoscopy. The identified patients were first treated with neoadjuvant chemotherapy (4 cycles of docetaxel 75mg/m2, cisplatin 75mg/m2 and 5-FU 300mg/m2) and then proceeded to cytoreductive surgery (including gastrectomy) combined with HIPEC (oxaliplatin 360mg/m2, 5-FU 400mg/m2 and leucovorin 20mg/m2). Adjuvant treatment was only conducted in cases of positive microscopic margins after surgery. Patients demographics were recorded. Major endpoints considered were short- and long-term survival, as well as morbidity and mortality of surgery. Overall survival, recurrence-free survival and cancer-specific survival were calculated using Kaplan-Meier estimators. Surgical morbidity was recorded using Clavien-Dindo classification. The study was approved by Ethics Committee of Geneva University Hospital.

Results

16 patients were included (male to female ratio 1:1). Mean age at surgery was 48.8 (+/- 8.7). All patients were operated by the senior author and considered free of macroscopic disease after surgery (completeness of cytoreduction CC0). Mean PCI score was 6 (+/- 4.3). 5 patients (31%) had positive margins at histopathological evaluation and 4 received adjuvant radiotherapy. Surgical complications were as follows : 1 Clavien 5 (death, 6.3%) and 1 Clavien 3b (6.3%). After a median follow-up of 17.5 months (2-63), median overall survival was 21 months (2-63), median recurrence-free survivall was 23 months (13-60) and median cancer-specific survival was 34 months.

Conclusions

Combined neoadjuvant and cytoreductive surgery associated with HIPEC is a feasible and safe protocol with acceptable mobidity and mortality in experienced centers. Considering the fact that the median overall survival in GC patients with PC is 9-10 months, this combined treatment allows to achieve better outcomes for selected patients.

Disclosure

All authors have declared no conflicts of interest.