RESULTS OF USING ADJUVANT SYSTEMIC AND INTRAPERITONEAL CHEMOTHERAPY IN PT1-4N1-3M0 GASTRIC CANCER TREATMENT

Introduction. The currently used standard of radically treating locally advanced gastric cancer (lGC) employs a combination of radical surgery and adjuvant polychemotherapy (APCT) that cannot prevent metachronous peritoneal dissemination (MPD), especially when treating infiltrative lGC. Therefore, it needs to be supplemented by intraperitoneal chemotherapy (ICT).

Objectives. Evaluating survival rates and cumulative incidence of рТ1-4N1-3M0 lGC after administering normothermic ICT and systemic capecitabine/oxaliplatin APCT.

Materials and methods. Long-term results of radical surgery performed on 341 lGC patients (pT1-4N1-3M0, type III-IV on the R. Borrmann scale) were analyzed. The adjuvant treatment comprised cisplatin-based normothermic ICT and capecitabine/oxaliplatin APCT. Long-term treatment results were analyzed by means of the Kaplan-Meyer multiplier estimation method, competing risks analysis to evaluate cumulative incidence (CI) of progression including that of MPD. The Fine-Gray model was used to assess the effect of ICT and APCT on the risks of tumor progression (MPD, distant lymphohematogenous metastases (RLHM) and their combinations).

Results. The application of normothermic ICT and APCT resulted in the decrease (1) in the 3-year CI of tumor progression in comparison to surgical treatment alone (59.7±3.1%), scoring after each of these procedures 48.3±9.6% and 37±6.9%, respectively, (рGray = 0.001); (2) in the 3-year MPD CI (in an isolated variant) in comparison to surgical treatment alone – (32.0±3.0%) – 17.2±7.2% и 7.7±3.8% (рGray < 0.001). Both normothermic ICT and APCT reduce the risk of developing MPD (in an isolated variant) in comparison to surgical treatment – HR 0.31 (95% confidence interval 0.12–0.80), р = 0.016and HR 0.17 (95% confidence interval 0.06–0.47), р < 0.001, without effecting RLHM and combined MPD+RLGM development risks (р > 0.05).

Conclusion. The possibility of preventing MPD after administering systemic APCT and normothermic ICT highlights the importance of accounting the extent of drug therapy in evaluating the probability of MPD development after lGC radical surgery.

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