Peritoneal metastasis is considered as the end stage of gastric cancer, which is a fatal malignancy without the chance of surgery. No standard regimens are recommended. Routine treatments can not improve the survival of these patients, while multidisciplinary treatments may probably be promising. Aggressive treatments such as cytoreductive surgery, intra-peritoneal chemotherapy and bidirectional chemotherapy are applied to clinical management in recent years. Furthermore, molecular targeted therapy and immune therapy are developed and making individualized treatment possible. Individualized treatment according to clinical characteristics and expression of biomarkers will be the future of peritoneal metastasis of gastric cancer.
Combined Modality Therapy ; Humans ; Peritoneal Neoplasms ; Precision Medicine ; Stomach Neoplasms

The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, we report on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimen of paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However, after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient's condition improved, and she has been progression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to the peritoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.
Carboplatin ; Cisplatin ; Drug Therapy ; Humans ; Infusions, Parenteral ; Neoplasm Recurrence, Local ; Ovarian Neoplasms ; Paclitaxel ; Peritoneal Cavity ; Peritoneal Neoplasms ; Recurrence ; Topotecan

Huge primary teratoma in the preperitoneal space is an extremely rare clinical entity and can be easily misdiagnosed as tumors of the intraperitoneal or pelvic origin. We report a case of primary huge mature teratoma in the preperitoneal space in a 74-year-old women, and reviews the clinical data and the diagnosis and treatment of this case. The patient underwent complete resection of the teratoma, which was the optimal treatment option. The patient was followed-up for 10 months and no signs of recurrence were found, suggesting a favorable prognosis.
Aged ; Female ; Humans ; Peritoneal Neoplasms ; diagnosis ; therapy ; Prognosis ; Teratoma ; diagnosis ; therapy

China is a country with a high incidence of gastric cancer, and the majority of patients are in the advanced stage. The peritoneum is the most common site of metastasis and recurrence in advanced gastric cancer. Attention to the standardized diagnosis and treatment of peritoneal metastases of gastric cancer is expected to significantly improve the prognosis and quality of life of some patients. Based on evidence-based medicine and the internationally accepted Delphi method, this consensus revises the Chinese expert consensus on the prevention and treatment of peritoneal metastasis of gastric cancer (2017 edition), reaches a preliminary consensus on the definition, classification, risk factors, diagnosis and prediction, grade assessment, prevention, treatment and management of complications of peritoneal metastasis of gastric cancer, and provides guidance for clinical work.
Humans ; Peritoneum/pathology* ; Peritoneal Neoplasms/therapy* ; Stomach Neoplasms/pathology* ; Consensus ; East Asian People ; Quality of Life ; China

Peritoneal metastasis is one of the common metastasis of gastrointestinal malignancy. Intraperitoneal chemotherapy (including hyperthermic intraperitoneal chemotherapy and intraoperative intraperitoneal chemotherapy) not only can effectively increase the peritoneal drug concentration, but also can reduce side effects of systemic chemotherapy. It can significantly prolong the long term survival of patients with peritoneal metastasis and improve the quality of life. In order to standardize the popularization and application of intraperitoneal chemotherapy, relevant professional committees have formulated expert consensus on intraperitoneal chemotherapy. However, there is no systematic guidance on the prevention and treatment of related complications of intraperitoneal chemotherapy. Under the guidance of the Complications Management Committee of the Colorectal Cancer Professional Committee of the Chinese Medical Association and the Colorectal Cancer Professional Committee of the Chinese Anti-cancer Association, we organized domestic experts in relevant fields to formulate this consensus according to the procedural specifications and relevant literature reports. This consensus aims to summarize the causes of common complications of intraperitoneal chemotherapy such as pneumonia, intraperitoneal hemorrhage, fever, peritonitis, ileus, intestinal dysfunction, anastomotic bleeding, anastomotic leakage, leakage or infection of perfusion tube, nausea and vomiting, myelosuppression, hepatic or nephritic dysfunction. After repeatedly soliciting the opinions of domestic authoritative experts and their discussion and modification, a consensus was formed to provide effective reference for the prevention and treatment of complications.
Humans ; Peritoneal Neoplasms/secondary* ; Hyperthermia, Induced ; Consensus ; Quality of Life ; Combined Modality Therapy ; Gastrointestinal Neoplasms/therapy* ; Perfusion ; Colorectal Neoplasms/surgery* ; China

BACKGROUND: Peritoneal carcinomatosis is the most common type of treatment failure in gastric cancer patients. For the purpose of decreasing the rate of peritoneal carcinomatosis, intraperitoneal chemotherapy is a very attractive treatment modality, especially in the aspect of direct infusion of the anti-cancer regimen into the peritoneal cavity. METHODS: The effects of intraperitoneal chemotherapy with cisplatin were evaluated using 360 gastric adenocarcinoma patients with serosal invasion who had received a curative gastric resection from June 1992 to June 1996. Among them, 136 cases were treated by installation of cisplatin 100 mg (mixed with 800 ml of normal saline) into the peritoneal cavity before closing the peritoneum, and the solution was drained out 2 hours later. An analysis was performed to determine the differences of survival rate and mode of recurrence between the intraperitoneal cisplatin installation group and the control group (who did not receive the intraperitoneal chemotherapy). RESULTS: The differences between those two groups were not statistically significant. We assume that such results were due to the patients being more advanced in the cisplatin-treated group than in the control group, although the comparison was between identically staged groups. CONCLUSIONS: Intraperitoneal chemotherapy with cisplatin did not show an improved survival rate and did not change the recurrent mode after surgery for serosal invasive gastric cancer. However, well- designed, prospective, randomized study should be performed. Also a prospective randomized study with other kinds of regimens or a more tolerable dose for each regimen will be needed for a correct evaluation of the effect of intraperitoneal chemotherapy.
Adenocarcinoma ; Carcinoma ; Cisplatin ; Drug Therapy* ; Humans ; Peritoneal Cavity ; Peritoneum ; Recurrence ; Stomach Neoplasms* ; Survival Rate ; Treatment Failure

Three large randomized trials (GOG-104, GOG-114, GOG-172) have shown the advantage of a combination of intravenous (IV) and intraperitoneal (IP) administration of chemotherapy over IV administration alone in optimally-debulked ovarian cancer. A significant advantage of IP chemotherapy is that high concentrations of drugs can be maintained within the peritoneal cavity with less systemic toxicity than IV chemotherapy of similar doses. Two pharmacokinetic problems appear to limit the effectiveness of IP chemotherapy: poor tumor penetration by the drug and incomplete irrigation of serosal surfaces by the drug-containing solution. Combined IP/IV administration of chemotherapy may be associated with a significantly increased short-term risk of toxicity compared with IV chemotherapy. However, the toxicity is usually short-term and manageable. Substitution of carboplatin for cisplatin may reduce the toxicity of IP platinum, but the optimal IP regimen for women with optimally-debulked ovarian cancer should be determined. In conclusion, patients with optimally-debulked FIGO stage III ovarian cancer should be counseled about the clinical benefit associated with combined IV and IP administration of chemotherapy.
Carboplatin ; Cisplatin ; Drug Therapy* ; Female ; Humans ; Infusions, Parenteral ; Ovarian Neoplasms ; Peritoneal Cavity ; Platinum

Intraperitoneal carcinomatosis accounts for 25~35% of recurrences of colorectal cancer, and peritoneal carcinomatosis from colorectal cancer has been regarded as a lethal condition. However, a combination of aggressive cytoreductive surgery and intraperitoneal chemotherapy has been tried and appears to be beneficial in selected patients. The primary goal of cytoreductive surgery is to remove all visible tumor within the peritoneal cavity. The goal of intraperitoneal chemotherapy is to eradicate the microscopic residual tumor and to prevent its recurrence. There are various ways to perform intraperitoneal chemotherapy. One is postoperative intraperitoneal chemotherapy, and another is intraoperative hyperthermic chemotherapy during surgery. Hyperthermia increases the penetration of chemotherapy into tissues and the level of chemotherapy cytotoxicity. The timing of surgery in cases of intraperitoneal chemotherapy and the optimal dosage of drugs must be evaluated in further studies. In colorectal cancer, the peritoneum should be regarded as an intra-abdominal organ, like the liver. Therefore, intraperitoneal carcinomatosis must be treated by using a combination of aggressive surgical treatment and intraperitoneal chemotherapy. Eventually, the long-term overall survival will be increased.
Carcinoma* ; Colorectal Neoplasms* ; Drug Therapy ; Fever ; Humans ; Liver ; Neoplasm, Residual ; Peritoneal Cavity ; Peritoneum ; Recurrence

The standard treatment for epithelial ovarian cancer is maximal cytoreductive surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy can be considered as an alternative treatment strategy when unacceptable primary surgery, in terms of gross residual tumor remaining at the end of cytoreduction, is expected or in cases where poor general condition renders extensive cytoreductive surgery unsuitable. Intraperitoneal chemotherapy is ideal for epithelial ovarian cancer because its spread is mainly limited to the peritoneal cavity. Several randomized controlled trials have reported a survival gain with intraperitoneal chemotherapy. However, disadvantages such as port-related complications, abdominal pain, and neurotoxicity hinder its wide use. Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been suggested as an alternative treatment strategy for intraperitoneal chemotherapy. Ongoing clinical trials of hyperthermic intraperitoneal chemotherapy will quantify clinical outcomes in the future, such as the survival benefit in epithelial ovarian cancer.
Abdominal Pain ; Chemotherapy, Adjuvant ; Drug Therapy* ; Neoplasm, Residual ; Ovarian Neoplasms* ; Peritoneal Cavity

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body but is not due to the local presence of cancer cells. Thus, successful treatment of the underlying tumor often improves such syndromes. Amylase-producing lung cancer, multiple myeloma, and ovarian cancer are reported only rarely. In Korea, no cases of hyperamylasemia have been reported in patients with primary peritoneal carcinoma. We report an interesting case of hyperamylasemia suspected to have been induced by primary peritoneal carcinoma. The patient's amylase isoenzyme patterns indicated salivary-type amylase. Hyperamylasemia was reduced in parallel with the response to chemotherapy. These data confirmed the diagnosis of amylase-producing primary peritoneal carcinoma.
Amylases ; Diagnosis ; Drug Therapy ; Humans ; Hyperamylasemia ; Korea ; Lung Neoplasms ; Multiple Myeloma ; Ovarian Neoplasms ; Paraneoplastic Syndromes ; Peritoneal Neoplasms