RESULTS OF USING ADJUVANT PERFUSION CHEMOTHERAPY IN RADICAL TREATMENT OF INFILTRATIVE GASTRIC CANCER

Abstract

Relevance: Given the high biological aggressiveness of infiltrative gastric cancer warranting a need for a multimodal approach to its radical treatment employing adjuvant perfusion thermochemotherapy (HIPEC) and systemic adjuvant polychemotherapy, the goal of the present study was to assess the efficacy and expediency of such an approach. The study aimed to evaluate the effectiveness of a combination of HIPEC and systemic adjuvant polychemotherapy in patients radically operated on for infiltrative forms of gastric cancer pT4a-bN0-3M0. Methods: The study examined the long-term results of radical treatment for gastric cancer in 141 patients (pT4a-bN0-3M0, Borrmann type III-IV). Of them, 18 patients underwent a multimodal treatment, including radical surgery in combination with HIPEC and systemic adjuvant polychemotherapy (ACT) (oxaliplatin 100 mg/m2 (on day 1 of the cycle), capecitabine 1,000 mg/m2 or tegafur 10-15 mg/kg (2 times per day, on days 1-14 of the cycle, with a 7-day break between cycles, 8 cycles) – HIPEC/ACT group. For comparison purposes, we used the data on 55 radically operated patients (surgery control) and 68 other patients who underwent radical surgery in combination with HIPEC (cisplatin 50 mg/m2 + doxorubicin 50 mg/m2, 420C, one hour). The long-term treatment results were evaluated using competing risks analysis, the Kaplan-Meier multiplier method, and multivariate analysis (Cox and Fine-Gray models). Results: The multimodal treatment group showed a decrease in unfavorable outcomes associated with tumor progression – β = -2.14; RR 0.12 (95% CI 0.04-0.38), р<0.001, as well as a decrease in the risk of carcinomatosis – β = -1.99; RR 0.14 (95% CI 0.04-0.44), р<0,001; and improvement in 5-year survival rates (as compared with the control groups), viz.: adjusted survival – 81.9±9.5% (р=0.003); progression-free survival – 82.2±9.3% (р<0.001); and dissemination-free survival – 81.9±9.5% (р<0.001). Conclusion: It is advisable to supplement the standard approach for infiltrative gastric cancer (radical surgery and systemic polychemotherapy) with perfusion HIPEC to prolong the remission of the tumor process.