Finally, a large number of cytokines released during wound healing and angiogenesis factors can be regarded as “nourishment”, which together constitute the microenvironment suitable for the formation of peritoneal metastasis.Īccording to the Chicago consensus on peritoneal metastasis in 2020, platinum and fluorouracil based regimens, including FOLFOX (oxaliplatin + calcium folinate + fluorouracil), XELOX (oxaliplatin + capecitabine), FLOT (docetaxel + calcium folinate + fluorouracil), ECF (epirubicin + cisplatin + fluorouracil) and SP (cisplatin + S-1), can be considered as the first-line chemotherapy for gastric cancer patients with peritoneal metastasis. Secondly, the rough separation surface caused by surgical detachment can form “soil”. Improper operation may also increase the risk of iatrogenic spread, such as the squeezing of tumor cells by the operator or the entrance of the abdominal cavity through the amputated lymph vessels and lymph vessels.
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As far as the source of seeds is concerned, as the primary lesion of gastrointestinal tumor penetrates the serosal layer and infiltrates into the surrounding tissues or organs, the tumor cells fall off and form peritoneal free cancer cells. “Seed soil” is the main theory to explain peritoneal metastasis. Therefore, peritoneal metastasis is the first cause of death in patients with gastric cancer, whether resectable or unresectable. It was reported that nearly 20% of gastric cancer patients were diagnosed with peritoneal metastasis (PM) before or during operation, while more than 50% of gastric cancer patients will have peritoneal metastasis in the future even after radical resection.
As China has not yet formed a perfect gastrointestinal tumor screening system, the early diagnosis rate needs to be improved, and most patients are in the advanced stage when diagnosed, even with distant metastasis. Among them, gastric cancer ranks fifth in all cancer incidence (5.7%) and mortality (8.2%). Registered 9 November 2016,Īccording to the global cancer statistics, there will be nearly 18.1 million new cancer cases in 2018, and estimated that there will be 9.6 million cases died of cancer related diseases.
Trail registrationĬhiCTR, ChiCTR-IIR-16009802.
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Large scale clinical trial is necessary to get more evidence to identify its efficacy. Survival time was significantly prolonged by conversion surgery. SOX+ip PTX regimen was effective in advanced gastric cancer with peritoneal metastasis. The grade 3–4 non-hematological toxicities were tolerated, most of which were peripheral sensory neuropathy (40%) due to oxaliplatin, diarrhea (20%), nausea and vomiting (26.7%). The grade 3–4 hematological toxicities were leucopenia (23.3%), neutropenia (23.3%), anemia (16.7%), and thrombocytopenia (20%), respectively. The median progression free survival (PFS) was 6.6 months (95% CI = 4.7–8.5 months) and the median overall survival (OS) was 15.1 months (95% CI = 12.4–17.8 months). There were 11 (36.7%) patients received conversion surgery. Of all these 30 patients, the median number of cycles was 6 (range 2–16) due to the limitation of hematotoxicity and peripheral neuropathy by oxaliplatin. Oxaliplatin was administered intravenously at an initial dose of 100 mg/m 2 on day1, and S-1 was administered orally at an initial dose of 80 mg/m 2 for 14 days followed by 7 days rest, repeated by every 3 weeks.
PTX was diluted in 1 l of normal saline and IP administered through peritoneal port at an initial dose of 40 mg/m 2 over 1 h on day1,8, respectively. Thirty patients diagnosed with advanced gastric cancer underwent laparoscopic exploration and were enrolled when macroscopic disseminated metastases (P1) were confirmed.
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In this study, we tried to access the efficacy and safety of oxaliplatin plus S-1 with intraperitoneal paclitaxel (PTX) for the treatment of Chinese advanced gastric cancer with peritoneal metastases.